Multisensory virtual reality reduces postoperative delirium in elderly patients undergoing laparoscopic gastrointestinal surgery: A single-centre randomised controlled trial.

BACKGROUND

Effective interventions for postoperative delirium (POD) remain unclear. Research indicates that light and sound stimulation may enhance the functional connectivity of the medial visual network, while olfactory stimulation improves cognitive function. This study aims to address POD by integrating auditory, olfactory and visual stimuli to develop a multisensory virtual reality device.

OBJECTIVE

To assess the effect of multisensory virtual reality on reducing POD in patients undergoing laparoscopic gastrointestinal surgery.

DESIGN

Randomised controlled trial.

SETTING

Single-centre tertiary hospital in China between September 2023 and July 2024.

PARTICIPANTS

A total of 342 patients aged 60 years or older, undergoing elective laparoscopic gastrointestinal surgery.

INTERVENTION: Participants were randomly assigned to either a multisensory virtual reality group, who received standard care along with a 20-min virtual reality session featuring a biophilic environment infused with juniper essential oil, or a standard care group, who received standard care alone for 20 min pre-operatively.

MAIN OUTCOME MEASURES: The primary outcome was the incidence of POD, assessed twice daily using the Confusion Assessment Method (CAM) for the three postoperative days. Secondary outcomes included pre-operative mean arterial pressure (MAP), heart rate (HR) and assessments of delirium severity, duration, anxiety levels and pain scores during the same postoperative period.

RESULTS

The incidence of POD during the three postoperative days was lower in patients assigned to the multisensory virtual reality group (9.4%, 16 of 170 patients) than in those assigned to the standard care group (19.2%, 33 of 172 patients), P  = 0.010. Multisensory virtual reality reduced preoperative anxiety scores and anxiety scores during the three postoperative days, P  = 0.001 for all. No serious adverse events occurred during the intervention.

CONCLUSIONS

The pre-operative use of multisensory virtual reality as a preventive measure may significantly reduce the incidence of POD during the first three postoperative 3 days after elective laparoscopic gastrointestinal abdominal surgery.

CLINICAL TRIAL NUMBER AND REGISTRY: Chinese Clinical Trials Registry, ChiCTR2300075624.