The Effect of Perioperative Music on Medication Requirement and Hospital Length of Stay: A Meta-analysis

Victor X Fu, Pim Oomens, Markus Klimek, Michiel H J Verhofstad, Johannes Jeekel, Victor X Fu, Pim Oomens, Markus Klimek, Michiel H J Verhofstad, Johannes Jeekel

Abstract

Objective: To assess and quantify the effect of perioperative music on medication requirement, length of stay and costs in adult surgical patients.

Summary background data: There is an increasing interest in nonpharmacological interventions to decrease opioid analgesics use, as they have significant adverse effects and opioid prescription rates have reached epidemic proportions. Previous studies have reported beneficial outcomes of perioperative music.

Methods: A systematic literature search of 8 databases was performed from inception date to January 7, 2019. Randomized controlled trials investigating the effect of perioperative music on medication requirement, length of stay or costs in adult surgical patients were eligible. Meta-analysis was performed using random effect models, pooled standardized mean differences (SMD) were calculated with 95% confidence intervals (CI). This study was registered with PROSPERO (CRD42018093140) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.

Results: The literature search yielded 2414 articles, 55 studies (N = 4968 patients) were included. Perioperative music significantly reduced postoperative opioid requirement (pooled SMD -0.31 [95% CI -0.45 to -0.16], P < 0.001, I = 44.3, N = 1398). Perioperative music also significantly reduced intraoperative propofol (pooled SMD -0.72 [95% CI -1.01 to -0.43], P < 0.00001, I = 61.1, N = 554) and midazolam requirement (pooled SMD -1.07 [95% CI -1.70 to -0.44], P < 0.001, I = 73.1, N = 184), while achieving the same sedation level. No significant reduction in length of stay (pooled SMD -0.18 [95% CI -0.43 to 0.067], P = 0.15, I = 56.0, N = 600) was observed.

Conclusions: Perioperative music can reduce opioid and sedative medication requirement, potentially improving patient outcome and reducing medical costs as higher opioid dosage is associated with an increased risk of adverse events and chronic opioid abuse.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA Flow diagram. N indicates number of studies.
FIGURE 2
FIGURE 2
Risk of bias summary. Risk of bias summary graph.
FIGURE 3
FIGURE 3
Effect of perioperative music on postoperative opioid requirement. Forest plot presenting the effect of perioperative music on postoperative opioid requirement (milligrams of morphine equianalgesics). CI indicates confidence interval; Mean, mean milligrams of morphine equianalgesics; N, total number of patients in study; NC, number of patients in the control group; NM, number of patients in the music group; PACU, post-anesthesia care unit; SD, standard deviation in milligrams of morphine equianalgesics; SMD, standardized mean difference.
FIGURE 4
FIGURE 4
Effect of perioperative music on intraoperative sedative medication requirement. Forest plot presenting the effect of perioperative music on intraoperative propofol (above) and midazolam (below) medication requirement. CI indicates confidence interval; Mean, mean milligrams of propofol or midazolam; N, total number of patients in study; NC, number of patients in the control group; NM, number of patients in the music group; OAA/S, observer assessment of alertness/sedation scale; PACU, post-anesthesia care unit; PCS, patient-controlled sedation; SD, standard deviation in milligrams of propofol or midazolam; SMD, standardized mean difference.
FIGURE 5
FIGURE 5
Effect of perioperative music on length of stay. Forest plot presenting the effect of perioperative music on length of stay. CI indicates confidence interval; Mean, mean length of stay; N, total number of patients in study; NC, number of patients in the control group; NM, number of patients in the music group; PACU, post-anesthesia care unit; SD, standard deviation; SMD, standardized mean difference.

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