Saudi Arabia’s tourism megaprojects are intended to do more than create visitor attractions. They are instruments of regional restructuring that can redirect investment, extend infrastructure networks, diversify local economies, improve access to peripheral destinations, and create new institutional relationships between national programs and local places. This review develops an integrated framework for understanding how those regional effects depend on four delivery capabilities: infrastructure planning, utility readiness, stakeholder coordination, and project delivery. Evidence published from 2020 to 2025 was synthesized across tourism development, spatial planning, construction management, sustainability, resilience, and digital project delivery. The literature indicates that destination success is weakened when hospitality assets advance faster than airports, roads, public transport, power, water, wastewater, digital connectivity, and municipal services. It also shows that stakeholder fragmentation, incomplete scope definition, late design changes, weak information exchange, and delayed approvals can convert strategic ambition into cost, schedule, and operational risk. Conversely, integrated spatial planning, early utility load modelling, transparent interface governance, digital coordination, and benefit-led delivery can transform individual projects into durable regional systems. The proposed framework treats a tourism megaproject as a regional platform rather than a bounded construction site. It links strategic objectives to spatial structure, enabling infrastructure, utility capacity, coordinated delivery, destination operations, and measurable regional benefits through a closed feedback loop. The review concludes that Vision 2030 outcomes will depend increasingly on the quality of integration between physical assets, institutions, local economies, and long-term operations, not simply on the completion of flagship facilities.