ArticlesMusic as an aid for postoperative recovery in adults: a systematic review and meta-analysis
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
References (33)
- et al.
Music modulation of pain perception and pain-related activity in the brain, brain stem, and spinal cord: a functional magnetic resonance imaging study
J Pain
(2014) - et al.
The sounds of music in the operating room
Injury
(2008) - et al.
Music as a nursing intervention for postoperative pain: a systematic review
J Perianesth Nurs
(2009) The anxiety and pain reducing effects of music interventions: a systematic review
AORN J
(2008)Implementation of complementary interventions in the Netherlands: experiences of pioneers
Patient Educ Couns
(2012)- et al.
Improved recovery and reduced postoperative stay after therapeutic suggestions during general anaesthesia
Lancet
(1988) - et al.
The incidence of intraoperative awareness in the UK: under the rate or under the radar?
Br J Anaesth
(2013) - et al.
Effect of noise on auditory processing in the operating room
J Am Coll Surg
(2013) FastStats: inpatient surgery
Surgery and the NHS in numbers
Pre-operative assessment and patient preparation. The role of the anaesthetist. AAGBI Safety Guideline
Reduction of postoperative pain by encouragement and instruction of patients
N Engl JMed
Enhanced recovery partnership project report
Notes on nursing: what it is, and what it is not
The phonograph in the operating room
JAMA
Music, neuroscience and the psychology of wellbeing
Front Psychol
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