The Surgical Soundtrack: The Effects of Music in the OR – Medscape

It was in 1914 that Pennsylvania surgeon Dr Evan O’Neil Kane first hauled a gramophone into the operating room.

Kane believed that playing soft, soothing music for surgical patients helped them relax prior to receiving anesthesia. The practice of incorporating music into clinical care soon caught on, and eventually surgeons began spinning records with their own mental state in mind. Yet, as it has for years, debate continues as to whether music in the OR is helpful or harmful—whether it might distract surgeons and put patients at risk or instead help to steady scalpel-wielding hands.

The Data

A 2007 study[1] found that noise levels in operating rooms can exceed 120 decibels, louder than a busy highway. And music could be seen as only adding to the clamor. But many surgeons swear by their surgical soundtracks, claiming that music in the OR calms them down, improves their performance, and helps them find their “flow,” that transcendent state of focus surgeons hope to achieve while operating.

Evidence on surgeons’ use of music in the OR is scant, but in a 2014 editorial[2] for the BMJ’s Christmas issue—which typically publishes on lighthearted medical topics—three surgeons from the University of Wales estimated that music is played between 62% and 72% of the time during surgery. (They jokingly recommended Coldplay’s “Fix You” and cautioned against Queen’s “Another One Bites the Dust.”)

A questionnaire-based study from 2011,[3] published in the Journal of Anaesthesiology Clinical Pharmacology, found that of 100 surveyed surgeons, anesthesiologists, and nurses in India, 87 were comfortable with music being played in the OR. Generally speaking, survey respondents reported that music helps them relax, improves cognitive function, and elevates their mood. As the study authors wrote, “Music helped in reducing the autonomic reactivity of [operating] theatre personnel in stressful surgeries, allowing them to approach their surgeries in a more thoughtful and relaxed manner.”

The evidence suggests that carefully self-selected music can have a beneficial effect on some surgeons during specific stages of the surgery.

A growing body of research has linked music in the OR with improved surgical performance, including a study[4] from 1994 reporting that listening to music of their choice can help experienced surgeons with simulated procedures. Similarly, in 2015, Texas plastic surgeon Dr Andrew Zhang co-published a study[5] in Aesthetic Surgery Journal reporting that not only did listening to music while operating improve the speed with which residents performed wound closures, but it also improved the quality of the repair, as assessed by blinded surgeon observers. The authors speculate that music may be a means of improving surgery efficiency and lowering healthcare costs.

“The evidence suggests that carefully self-selected music can have a beneficial effect on some surgeons during specific stages of the surgery,” says Dr Jonathan D. Katz, a clinical professor of anesthesiology at Yale University School of Medicine who has studied the effects of noise on surgical outcomes.

Yet Katz points out that music in the OR affects each member of the operating team differently. “It is not clear that music benefits less experienced surgeons, who can become distracted from their primary tasks by background noise, including music,” he comments, citing a 2008 randomized controlled trial[6] suggesting that music in the OR has a disruptive effect on novice surgeons.

He also points to other work[7-10] showing that music and other distractions, perhaps expectedly, can impair communication among the surgical team and hinder surgeon performance. One study even found that excessive OR noise increased the incidence of surgical-site infections.[11]

As one surgeon (who asked to remain anonymous) commented to Medscape, “I used to do music in the OR, but I began to find it distracting. I think it’s become a badge of cool, and I am in favor of treating surgery seriously.”

I used to do music in the OR, but I began to find it distracting. I think it’s become a badge of cool, and I am in favor of treating surgery seriously.

Still, the vast majority of surgeons I interviewed for this article prefer to operate to music.

“I recently learned of the evidence that listening to music you enjoy enhances creativity and facilitates one’s ability to perform a task,” says Dr Robert G. Marx, an orthopedic surgeon at Hospital for Special Surgery (HSS) in New York City. “I realized that I do indeed feel happier and in a better mood when listening to music I like. Feeling relaxed in the operating room is helpful, and I now bring my music collection to the OR on my phone.”

Dr David Brenin, a cancer surgeon at the University of Virginia, concurs.

“Of course it’s probably case-by-case with the specific surgeon, but I often listen to music while operating. It helps me relax and get in the zone,” he says, adding that scoring surgeries has gotten easier and easier thanks to streaming services like Pandora and Spotify. “When I was a resident in the ’90s, we of course had to bring CDs—which was often the resident’s job and which limited the selection. Now we pick any playlist we want with the touch of a button.”

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