Studies have shown that playing music in the operating room (OR) while performing surgery can benefit operative staff by improving their levels of physiologic stress and enhancing operative performance. However, other investigations have shown that playing music in the OR can impede anesthesiologists’ concentration and impair surgeons’ performance as well as their ability to manage stressful situations.

“Safety in the OR is highly dependent on team performance,” says Claudius Conrad, MD, PhD. “When performing extensive surgeries, a heterogeneous team must work well together to achieve optimal outcomes.” Little is known about the impact of playing music on OR team concentration and communication. Data are also lacking with regard to whether or not music preferences and perceptions in the OR differ by demographic and professional factors.

Surveying the Scene

For a study published in Surgery, Dr. Conrad and colleagues conducted a multi-institutional analysis of more than 280 preoperative patients and nearly 400 attending physicians, residents, and nurses in anesthesiology and surgery. “We designed and utilized a questionnaire that would globally test how music is perceived in the OR, what is important when music is being played, and the differential perceptions of music by the various groups participating in the analysis,” explains Dr. Conrad. “We also wanted to understand patient’s opinions about whether music should be played in the OR and, if so, whether they would want their surgeon to determine what music should be played.”

According to the survey results, patients highly favored playing music in the OR, with 43% indicating that music should be played often. When asked who should choose the music that is played in the OR, 82% of patients indicated that the choice should be determined by the surgeon and/or the OR team rather than patients. Overall, study participants perceived music to improve concentration among the OR team. About 75% of patients expressed having a high personal enjoyment of music, which was associated with their beliefs that music alleviates stress, enhances performance and concentration, and should be played in the OR.

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As a whole, healthcare providers reported substantial enjoyment with playing music in the OR. However, nurses and residents had higher average music enjoyment scores than attending physicians, and surgery providers had higher scores than anesthesiology providers (Figure below).

conrad figure

“When we looked at genre and tempo preferences, we found surprisingly strong differences between anesthesiologists and surgeons,” says Dr. Conrad. “In general, anesthesiologists preferred ‘reflective’ music, such as jazz, blues and classical music. These genres tend to have slower tempos and lower noise pressure levels. On the other hand, surgeons preferred faster-paced music. Our results suggest that loud, fast-paced music can compromise the ability of anesthesiologists to monitor information  that which is encoded in auditory alarms.” Dr. Conrad notes that surgeons’ preferences support results from previous studies in athletes suggesting that faster-paced music helps to reduce perceived exertion during endurance exercise. “Faster-paced music would theoretically help surgeons overcome prolonged, strenuous motor performances,” he says.

Prior research has found that musical taste appears to be closely correlated with a person’s primary personality. “For example,” Dr. Conrad says, “nurses tend to be younger, female, and have lower incomes than physicians. These factors have been shown to be strong predictors of favoring pop music, and we observed this correlation among nurses in our study.”

Hitting the Right Note

With strong differences in opinions, Dr. Conrad says the key to successful use of music in the OR is to find a common denominator that works best for the most people on the surgical team. “In that context, we found that classical music can be a good compromise for many people,” he adds. “However, differing opinions on music can also be overcome by discussing musical preferences. This can potentially improve safety in the OR. Initiating communication about music can also help overcome hierarchical barriers early in the surgery. Surgeons who tell the OR team what music they like and ask if everyone is comfortable with listening to it are likely to be perceived as being interested in the team and open to input from others.”

Dr. Conrad says music in the OR is analogous to the effects of that drugs can have on patients. “Music in the OR can have positive effects or negative side effects and should be dosed similarly to a drug,” he says. “There might be times when no music is best and there might be times when music can help to improve communication between the individual members of the OR team.”

Claudius Conrad, MD, PhD, has indicated to Physician’s Weekly that xx has no financial interests to disclose.