Music as an aid for postoperative recovery in adults: a systematic review

Background: Music is a relatively non-invasive, safe and inexpensive intervention that can be delivered easily and successfully. This systematic review evaluated music to improve postoperative recovery after surgical procedures. Methods: Randomised controlled trials (RCTs) in any language of adults undergoing surgical procedures excluding central nervous system or head and neck were included. Any form of music initiated before, during or after surgery was compared to standard care or other non-drug interventions. Medline (1946-Oct 2013), Embase (1947-Oct 2013), CINAHL (1960-Oct 2013), and Cochrane Central (1898-Oct 2013) were searched, using MESH and keyword terms: music, music therapy, surg*, operat*, recovery, recuperation, rehabilitation, convalescence, post-op*. Inclusions, data-extraction and quality-assessment were in duplicate. Meta-analysis with RevMan (5.2), with standardised mean differences (SMD) and random-effects models, and STATA for meta-regression were used. (Prospero-CRD42013005220). Results: Searches found 4261 titles and abstracts, 73 RCTs were included, with size varying between 20–458 participants. Choice of music, timing and duration varied. Comparators included routine care, headphones with no music, white noise and undisturbed bed-rest. Postoperatively music reduced pain (SMD -0.77 (95% confidence intervals (95%CI) -0.99 to -0.56), anxiety SMD -0.68 (95%CI -0.95 to -0.41), and analgesia use SMD -0.37 (95%CI -0.54 to -0.20) and increased patient satisfaction SMD 1.09 (95%CI 0.51 to 1.68) but there was no difference in length of stay (MD -0.11 (95%CI -0.35 to +0.12)). Music reduced 10cm scale pain scores by 2.3cm compared to placebo. Subgroup analyses on choice and timing made little difference. Meta-regression found no causes of heterogeneity in eight variables evaluated. Music was effective even when patients were under general anaesthetic. Conclusions: There is now evidence to demonstrate that music should be available to all undergoing operative procedures. Patients should choose the type of music, from personal choice or playlists. Timing and delivery may be adapted to individual clinical settings and medical teams.