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Clinician Article

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



  • Hole J
  • Hirsch M
  • Ball E
  • Meads C
Lancet. 2015 Oct 24;386(10004):1659-71. doi: 10.1016/S0140-6736(15)60169-6. Epub 2015 Aug 12. (Review)
PMID: 26277246
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Disciplines
  • Surgery - Colorectal
    Relevance - 6/7
    Newsworthiness - 6/7
  • Surgery - Plastic
    Relevance - 6/7
    Newsworthiness - 6/7
  • Surgery - General
    Relevance - 6/7
    Newsworthiness - 5/7
  • Anesthesiology
    Relevance - 6/7
    Newsworthiness - 4/7
  • Surgery - Oncology
    Relevance - 6/7
    Newsworthiness - 3/7
  • Special Interest - Pain -- Physician
    Relevance - 5/7
    Newsworthiness - 6/7
  • Surgery - Ear Nose Throat
    Relevance - 5/7
    Newsworthiness - 6/7
  • Surgery - Gastrointestinal
    Relevance - 5/7
    Newsworthiness - 6/7
  • Surgery - Thoracic
    Relevance - 5/7
    Newsworthiness - 5/7
  • Surgery - Urology
    Relevance - 5/7
    Newsworthiness - 5/7
  • Surgery - Ophthalmology
    Relevance - 5/7
    Newsworthiness - 4/7
  • Surgery - Vascular
    Relevance - 5/7
    Newsworthiness - 4/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 4/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 4/7
    Newsworthiness - 5/7
  • Hospital Doctor/Hospitalists
    Relevance - 4/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 4/7
    Newsworthiness - 5/7
  • Surgery - Orthopaedics
    Relevance - 4/7
    Newsworthiness - 4/7
  • Surgery - Cardiac
    Relevance - 4/7
    Newsworthiness - 3/7

Abstract

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.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

In addition to a television remote, hospitalized patients should have the option to access a music service like Spotify. Noise canceling headphones would likely be too costly. It`s time to "rock n` roll" with the information presented in this article.

General Internal Medicine-Primary Care(US)

At our medical center, we are struggling mightily with narcotic use, overuse and addiction. If music reduces pain and anxiety, we should use it.

Hospital Doctor/Hospitalists

Although the review deals with postoperative recovery, music might also be helpful in other painful conditions and therefore interesting for hospitalists.

Internal Medicine

Low-cost, low-tech intervention with pretty good results!

Special Interest - Pain -- Physician

The authors of this review demonstrated that music may decrease pain and analgesic requirement in the perioperative period. Music does not get rid of the pain, but it does make it more bearable. The approach is rather simple and easy to use. Hospitals are depressing places. Anything that distracts from being in hospital, such as music, is most likely to decrease pain and analgesic requirement.

Special Interest - Pain -- Physician

A non-pharmacologic measure to improve the recovery after surgery is of interest. Music is seemingly safe, risk-free, could obviously improve patient satisfaction, and reduce sensation of pain and anxiety. Providing patients the option to listen to music should be readily available during the recovery following surgery.

Surgery - Colorectal

This systematic review that included 73 RCTs showed that music reduced postop pain and anxiety but had no effect on postop length-of-stay.

Surgery - Oncology

This article adds nothing new to what we already know.

Surgery - Ophthalmology

These are very useful data. However, in ophthalmology, the post-op period at the hospital is short. I am more interested in the intra-operative period.

Surgery - Plastic

I have no personal experience with this, but music may be an additional postoperative therapy.

Surgery - Plastic

I always thought that music could be useful in relaxing. However, this work definitely demonstrates that it can modify some relevant aspects of postoperative period. It is an interesting information since it can be implemented with very low costs and it could probably positively influence therapeutic costs.

Surgery - Urology

It is nice to have a systematic review on this topic, but it is not a practical intervention in real life. The benefit seems quite limited and may be useful in very select patients. I`ll probably end up telling patients, "if you want to bring your headphones with music you like, it wouldn`t be a bad idea".

Surgery - Vascular

While some ORs/surgeons may debate the presence of music in the surgical environment, this scholarly review offers supportive evidence of a direct patient benefit. This is manifested as decreased pain, analgesic requirements, and anxiety as well as increased patient satisfaction. While a financial benefit (decreased length of stay) was not realized, the editorial reminds the reader that companies "have profited from the mood-altering effects of music". There were no recognized side-effects but only a caution to avoid masking communication between the involved parties with an inexpensive adjunct to improved patient satisfaction-- something all competitive medical facilities would be interested in.

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