Surgeon Preference and Music in the Operating Room: a Randomized, Controlled Trial

by Marie Crandall, MD, MPH, FACS

Background: Music in the operating room has been studied fairly extensively, mostly in the context of ambient music used to decrease anesthetic requirements during surgery. However, very little has been written about musical preferences of the operating surgeon, which is arguably very important, as “ambient” music often translates into that irritating New Age music which meanders aimlessly, relying heavily on woodwinds and bird tweets, and defies all rhythm or syncopation. Still, apparently it’s very helpful to patients who are not actively driven to poke their eyes out with stray syringes of propofol having to listen to that nonsense.

Methods: The authors (A.K.A. me) decided to conduct a randomized, controlled trial of surgeon-directed music in the operating room (OR). Except that randomization is sort of painful, in that there has to be blinding, measurement of covariates, and I really only had a week. So, instead, I performed a population-based survey, by sending out an email and posting a Facebook notice querying surgeons about their OR musical preferences. I guess one could quibble about the “population-based” aspects, as I mostly just emailed the cool women surgeons whose email addresses were in my Outlook contacts, and well, I suppose my Facebook friends are not exactly a random sample of American surgeons. Oh, yeah, and I only asked women. Just because. But I digress. Four questions were asked, “1. Do you listen to music in the OR?, 2. Is it your music?, 3. Do you let residents pick the music?, and 4. What do you listen to?” (yes, I know I ended the question with a preposition, but remember this is a population-based survey, and EVERYONE does it, ok I’ll change it. See Table 1 below).

Results: Seventeen attending women surgeons responded to the survey (100% response). Nearly all respondents listen to music in the OR. Most bring their own music, but some attendings allow the residents, nurses, and anesthesiologists to choose music. A theme emerged that many surgeons will turn off the music when a patient is unstable. Those who always listen to their own music were fairly vehement about it. Otherwise, musical preferences are all over the map and completely contradictory to each other, defying any kind of theme analysis. And some people listen to really terrible music, as you can see for yourself in Table 1 below.

Table 1: Survey of badass* attending surgeon musical preferences

Question	N (%)	Comments
1.     Music in OR? Yes No	16 (94%) 1  (6%)	“If it’s an unstable patient, I turn the music off,”  “Occasionally it’s distracting when I have to make sure anesthesia is not slipping some pressors in the IV,”  “Will turn tunes on when out of the danger zone,”  “No music allowed. Focused concentration mandatory”
2.     Your music? Yes No	10 (59%) 7  (41%)	“Really?  That’s the absolute best thing about being an attending, choosing the OR music.  That and wearing pajamas every day to work.”
3.     Let residents pick music? Yes No	12  (71%) 5  (29%)	“NEVER,” “Yes, unless it sucks”
4.     Musical choices? Neurosurgery resident playlist; Pandora, dance music  (all decades); “Mostly alt country/Americana with a little Southern rock thrown in; Drive-By Truckers for nec fasc”, “Washed Out, Wye Oak, Beach House, Sharon Van Etten, Wild Nothing, Iron & Wine, Silent Years, Alela Diane, Army Navy”; ‘80s, upbeat dance music, “My Sharona”; “Top 40 radio, classic rock, top 40, jazz, classical”; “Electronica is my office default, but it’s not appropriate in the OR”; contemporary pop; “OR specific playlists with Pink, Indigo Girls, Patrice Pike, Bonnie Raitt, Tim McGraw, Lady Antebellum, Shawn Colvin, The Rescues, just to name a few”;  Indian and American club music; “I use Pandora; liver transplants get 80s pop or Vanilla Ice mix, liver resections get Abba or Pink”, “my iPod (all decades)”; “A mix on Pandora, what it is depends a bit on the case and time of day,  one of our night scrub techs is a huge Disney fan so we tend to play Disney Pandora and have a name that tune session” ; “My music is the best.  I have everything from Metallica to Otis Taylor to Agent Orange to Santana.  If you hate the current song, wait til the next one.” Pertinent negatives:  no country (x2), no musicals, no rap, no metal, no Britney Spears, no Taylor Swift, no Justin Bieber, no smooth jazz

*badass (adj). Used to describe all study participants; indicates clarity of mind, a humorous disposition, and excellence in the field of surgery

Conclusions: My first conclusion is that most of us are united in turning off the music to enhance concentration, consistent with previously published research. Second, in this non-randomized, uncontrolled, not remotely population-based survey of experts in the field of surgery, there is a wide variety of music played in the OR. And, finally, the near-unanimous agreement that the best music to be heard in any OR anywhere is that of Marie Crandall, MD, MPH, FACS.

What music do you like to play in the OR? Let us know in the comments below.

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Marie Crandall, MD, MPH, FACS is an Associate Professor of Surgery and Preventive Medicine in the Division of Trauma and Critical Care at Northwestern University Feinberg School of Medicine. She is originally from Detroit, MI, a product of Head Start and local public schools. Dr. Crandall obtained a Bachelor’s Degree in Neurobiology from U.C. Berkeley in 1991, and completed her M.D. in 1996 at the Charles R. Drew/U.C.L.A program in Los Angeles. She finished her General Surgery residency at Rush University & Cook County Hospital in 2001, and in 2003, completed a Trauma & Surgical Critical Care Fellowship at Harborview Medical Center in Seattle, WA. During her fellowship, she obtained a Masters in Public Health from the University of Washington. Dr. Crandall performs emergency general and trauma surgery, staffs the SICU, and is an active health services researcher. Dr. Crandall loves travel, triathlons, hiking, and is a passionate animal rights activist; you can follow her on Twitter @vegansurgeon.