Elsevier

The Lancet

Volume 386, Issue 10004, 24–30 October 2015, Pages 1659-1671
The Lancet

Articles
Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis

https://doi.org/10.1016/S0140-6736(15)60169-6Get rights and content

Summary

Background

Music is a non-invasive, safe, and inexpensive intervention that can be delivered easily and successfully. We did a systematic review and meta-analysis to assess whether music improves recovery after surgical procedures.

Methods

We included randomised controlled trials (RCTs) of adult patients undergoing surgical procedures, excluding those involving the central nervous system or head and neck, published in any language. We included RCTs in which any form of music initiated before, during, or after surgery was compared with standard care or other non-drug interventions. We searched MEDLINE, Embase, CINAHL, and Cochrane Central. We did meta-analysis with RevMan (version 5.2), with standardised mean differences (SMD) and random-effects models, and used Stata (version 12) for meta-regression. This study is registered with PROSPERO, number CRD42013005220.

Findings

We identified 4261 titles and abstracts, and included 73 RCTs in the systematic review, with size varying between 20 and 458 participants. Choice of music, timing, and duration varied. Comparators included routine care, headphones with no music, white noise, and undisturbed bed rest. Music reduced postoperative pain (SMD −0·77 [95% CI −0·99 to −0·56]), anxiety (−0·68 [–0·95 to −0·41]), and analgesia use (−0·37 [–0·54 to −0·20]), and increased patient satisfaction (1·09 [0·51 to 1·68]), but length of stay did not differ (SMD −0·11 [–0·35 to 0·12]). Subgroup analyses showed that choice of music and timing of delivery made little difference to outcomes. Meta-regression identified no causes of heterogeneity in eight variables assessed. Music was effective even when patients were under general anaesthetic.

Interpretation

Music could be offered as a way to help patients reduce pain and anxiety during the postoperative period. Timing and delivery can be adapted to individual clinical settings and medical teams.

Funding

None.

Introduction

Most people undergo a surgical procedure at some point in their lives—more than 51 million operative procedures are done every year in the USA,1 and 4·6 million hospital admissions per year in England lead to surgical care.2 A trend is emerging towards undertaking surgical procedures without general anaesthesia—for example, hysteroscopy and caesarean section. Irrespective of whether anaesthesia is used, the postoperative period is a difficult time for patients. The term postoperative recovery has not been precisely defined, but is clinical and includes restoration of the patient's cerebral and motor function. Surgical recovery strategies, such as Enhanced Recovery (a set of interventions aimed at improving patient outcomes and reducing their length of stay in hospital),3, 4, 5 recommend several successful perioperative interventions. Some preoperative strategies, such as patient education and nutritional additives, reduce postoperative analgesia needs and improve patient satisfaction,3, 4, 5 but not all potentially useful interventions have been assessed or incorporated.

Use of music to improve patients' hospital experience has a long history in medical care, including by Florence Nightingale.6 Music was first described being used to help patients during operations by Evan Kane7 in 1914. Several studies have investigated music's effect on emotions and neurophysiology.8, 9, 10 Pre-recorded music through headphones, musical pillows, or background sound systems can be a non-invasive, safe, and inexpensive intervention compared with pharmaceuticals, and can be delivered easily and successfully in a medical setting.11 Music has frequently been investigated in the context of recovery from operative procedures, and several randomised controlled trials (RCTs) have shown positive effects on patients' postoperative recovery.12, 13 This use of music differs from music therapy, which is a cognitive rehabilitation method.14

Previous systematic reviews have investigated music and its role in specific surgical procedures, such as colonoscopy,15, 16 or in only one aspect of patient experience in isolation, such as preoperative anxiety17 or postoperative pain.18, 19 Cepeda and colleagues20 investigated use of music for pain relief in both surgical and non-surgical settings. Nilsson21 comprehensively reviewed 60 articles about use of music in the perioperative period but did not do a meta-analysis.21 No previous reports have provided a comprehensive overview with meta-analyses and meta-regression.

At present, music is not used routinely perioperatively. Until now, scarcity of uptake might be due to ignorance or scepticism about the effectiveness of music.22

Despite the large number of relevant studies, music has not been implemented as a therapeutic intervention in everyday surgical practice because information about effectiveness has not been synthesised and disseminated universally. We assess effectiveness of music in improvement of postoperative recovery, incorporate all available RCTs, review effects of music on common outcome measures for postoperative care (pain, analgesia needs, anxiety, and length of stay), and investigate relevant subgroups (patient choice of music, timing of intervention, and whether general anaesthesia was used).

Section snippets

Search strategy and selection criteria

The predefined inclusion criteria were RCTs in any language with adult patients undergoing any form of surgical procedure (with or without sedation or anaesthesia) to any part of the body excluding the central nervous system or head and neck (because of potential hearing impairment). We compared any form of music initiated before, during, or after surgery with standard care or any other non-drug interventions such as massage, undisturbed rest, or relaxation. Outcomes of interest were:

Results

We identified 4261 titles and abstracts, of which we assessed 260 articles for inclusion (238 from database searches and 22 from reference lists; figure 1). We included 73 RCTs in the qualitative synthesis and 72 RCTs in quantitative syntheses (listed in the appendix), excluding one study that did not have quantitative data. Publication bias is not likely to have much effect on our findings because studies are evenly distributed either side of the SMD for postoperative pain (−0·77) (figure 2).

Discussion

Our systematic review and meta-analysis suggests that music played in the perioperative setting can reduce postoperative pain, anxiety, and analgesia needs, and improve patient satisfaction. However, we identified no difference in length of stay, although few studies measured it. None of the studies investigated effects of music on infections, wound healing rates, or costs.

We used wide inclusion criteria to make results more generalisable to clinical practice. One could argue that we should not

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