Disclaimer: This article is intended solely for informational and educational purposes only. It does not constitute medical advice.

Music has been a fixture of the operating room (OR) since the early 20th century, yet its role and impacts in modern surgical practice remain a subject of ongoing debate. While surveys consistently reveal that most surgical staff favor listening to music while working, clinical discussions center on three distinct domains: patient-facing physiological and psychological benefits, surgical team performance and communication, and safety concerns regarding ambient noise and distraction. 

The strongest, least-contested argument in favor of OR music lies in direct patient outcomes. Large-scale meta-analyses demonstrate that music reduces perioperative anxiety, pain, and total opioid and sedative requirements, even when administered while the patient is under general anesthesia. For instance, a meta-analysis encompassing 92 randomized studies with 7,385 patients found that music interventions significantly reduced perioperative anxiety.¹ A more recent meta-analysis quantified this in clinically intuitive terms. In the researchers’ analysis, they found that the number needed to meaningfully reduce perioperative anxiety with music is just four, representing an effectiveness the authors compared to benzodiazepines, but without the pharmacologic downsides.² 

In addition to reducing anxiety, music plays a well-documented role in perioperative pain management. The same meta-analysis of 92 randomized trials demonstrated a significant reduction in postoperative pain scores.¹ Furthermore, a meta-analysis of 55 randomized controlled studies involving 4,968 patients found that perioperative music significantly reduced postoperative opioid requirements while lowering the necessary intraoperative doses of propofol and midazolam required to achieve adequate sedation depth.³ Intraoperative music, even under general anesthesia, significantly reduced postoperative pain and opioid requirements, supporting the idea that auditory stimuli are processed during adequate anesthesia.⁴ In an era of opioid stewardship, this positions music as a low-cost, essentially risk-free adjunct to standard perioperative care. 

Beyond patient outcomes, music can positively influence the surgical team’s physiological baseline and interpersonal environment. A systematic review concluded that background OR music reduced heart rate, blood pressure, and physical muscle effort in surgeons while improving accuracy on surgical tasks, with classical music at low-to-medium volume appearing most favorable.⁵ Qualitatively, staff describe music as fostering team cohesion, elevating shared mood, and creating a “therapeutic space.”^6,7 

Conversely, the chief argument against OR music in the ongoing debate is its potential to compete for cognitive attention during crucial moments. The American Heart Association’s scientific statement on cardiac OR safety highlights that a randomized controlled trial found OR music had a detrimental effect on the surgical performance of novice laparoscopic surgeons, and that 25% of surveyed anesthesiologists reported OR music impaired their ability to communicate with other staff.⁸ Because each OR sub-team carries a different cognitive workload at different points in a case, OR music pleasing to one member can be distracting to another when focus is needed. 

Furthermore, music adds acoustic decibels to an environment that is already prone to high levels of noise. A systematic review evaluating surgical environments found that baseline noise levels frequently exceed recommendations established by the World Health Organization. They found that high noise levels correlate with increased surgical complication rates, including surgical-site infections, while over half of surveyed operating room staff classify excessive noise as a major stressor that degrades overall performance.⁹ A 2025 systematic review of environmental factors reached the same conclusion, confirming that ambient noise consistently exceeds safety thresholds, increases clinician cognitive load, and correlates with elevated patient complication rates.¹⁰ 

A recurring theme within the literature is a mismatch between staff perception and objective performance data. The 2025 review of environmental factors found that although music was viewed positively, it did not objectively enhance performance.¹⁰ Investigations into simulated surgical conditions reveal that background music does not improve speed or technical accuracy, fails to reduce subjective task load, and can actually accentuate physiological markers of stress across both novice and experienced surgeons.¹¹ Qualitative assessments further emphasize that music is not a universal solution; the same acoustic environment that builds team cohesion in one setting can exacerbate interpersonal tension, reinforce workplace hierarchies around playlist control, and disproportionately burden specific team members.¹¹ Determining who controls the sound system, and whether junior staff feel empowered to request silence, remains a genuine workplace culture challenge. 

The debate regarding the presence of music in the OR is less about its potential benefits or detriments than it is about the type, volume, and timing of music that is played. Patient-directed music (e.g., headphones) is the least controversial and best-supported application, delivering anxiolytic and analgesic benefit without adding ambient noise or distracting the team.^1,3 Genre and volume matter as well. For example, classical music at low-to-medium volume is most consistently associated with benefit, whereas loud or high-tempo music is where distraction concerns concentrate.^5,6  

To preserve safety, music must remain strictly controllable and yield to clear communication at a moment’s notice. It should be paused during critical procedural phases, induction, emergence, equipment counts, and any high-stakes verbal exchanges.⁸ Less experienced clinicians may also require a quiet environment to maintain concentration compared to seasoned operators.⁸ Rather than deferring entirely to a single individual, the preferences and cognitive needs of the entire surgical team deserve equal weight to safeguard both communication flow and patient outcomes.¹¹ Controlled, low-volume music used with unanimous team consent offers a balanced approach that maximizes patient comfort while safeguarding team performance. 

References 

1. Kühlmann AYR, de Rooij A, Kroese LF, van Dijk M, Hunink MGM, Jeekel J. Meta-analysis evaluating music interventions for anxiety and pain in surgery. Br J Surg. 2018 Jun;105(7):773-783. doi: 10.1002/bjs.10853. Epub 2018 Apr 17. PMID: 29665028; PMCID: PMC6175460. 

2. Stoop JM, Verhoeven JG, Hoeks S, Jeekel J, Klimek M. The Number Needed to Treat for Music as a Medicine against Perioperative Anxiety: A Systematic Review and Meta-Analysis. Anesth Analg. 2026 Apr 1;142(4):625-634. doi: 10.1213/ANE.0000000000007815. Epub 2026 Mar 13. PMID: 41294333; PMCID: PMC12959583. 

3. Fu VX, Oomens P, Klimek M, Verhofstad MHJ, Jeekel J. The Effect of Perioperative Music on Medication Requirement and Hospital Length of Stay: A Meta-analysis. Ann Surg. 2020 Dec;272(6):961-972. doi: 10.1097/SLA.0000000000003506. PMID: 31356272; PMCID: PMC7668322. 

4. Fu VX, Sleurink KJ, Janssen JC, Wijnhoven BPL, Jeekel J, Klimek M. Perception of auditory stimuli during general anesthesia and its effects on patient outcomes: a systematic review and meta-analysis. Can J Anaesth. 2021 Aug;68(8):1231-1253. doi: 10.1007/s12630-021-02015-0. Epub 2021 May 19. PMID: 34013463; PMCID: PMC8282577. 

5. Moris DN, Linos D. Music meets surgery: two sides to the art of “healing”. Surg Endosc. 2013 Mar;27(3):719-23. doi: 10.1007/s00464-012-2525-8. Epub 2012 Oct 6. PMID: 23052506. 

6. El Boghdady M, Ewalds-Kvist BM. The influence of music on the surgical task performance: A systematic review. Int J Surg. 2020 Jan;73:101-112. doi: 10.1016/j.ijsu.2019.11.012. Epub 2019 Nov 22. PMID: 31760139. 

7. Narayanan A, Khashram M, Fisher JP. Randomized cross-over trial comparing stress responses amongst undergraduates and surgeons with and without background music during simulated surgery. Sci Rep. 2025 Jun 3;15(1):19461. doi: 10.1038/s41598-025-02202-9. PMID: 40461582; PMCID: PMC12134096. 

8. Wahr JA, Prager RL, Abernathy JH 3rd, Martinez EA, Salas E, Seifert PC, Groom RC, Spiess BD, Searles BE, Sundt TM 3rd, Sanchez JA, Shappell SA, Culig MH, Lazzara EH, Fitzgerald DC, Thourani VH, Eghtesady P, Ikonomidis JS, England MR, Sellke FW, Nussmeier NA; American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular and Stroke Nursing, and Council on Quality of Care and Outcomes Research. Patient safety in the cardiac operating room: human factors and teamwork: a scientific statement from the American Heart Association. Circulation. 2013 Sep 3;128(10):1139-69. doi: 10.1161/CIR.0b013e3182a38efa. Epub 2013 Aug 5. Erratum in: Circulation. 2013 Sep 17;128(12):e192. PMID: 23918255. 

9. Fu VX, Oomens P, Merkus N, Jeekel J. The Perception and Attitude Toward Noise and Music in the Operating Room: A Systematic Review. J Surg Res. 2021 Jul;263:193-206. doi: 10.1016/j.jss.2021.01.038. Epub 2021 Mar 4. PMID: 33677147. 

10. Boyle CP, Crichton J, Sgrò A, Michael SH, Wigmore SJ, Skipworth RJE, Yule S. Impact of environmental factors on operative team performance: systematic review and guidance for optimising clinical practice. Surg Endosc. 2025 Dec;39(12):7983-7999. doi: 10.1007/s00464-025-12362-4. Epub 2025 Nov 11. PMID: 41219560; PMCID: PMC12708707. 

11. Narayanan A, Khashram M, Fisher JP. Randomized cross-over trial comparing stress responses amongst undergraduates and surgeons with and without background music during simulated surgery. Sci Rep. 2025 Jun 3;15(1):19461. doi: 10.1038/s41598-025-02202-9. PMID: 40461582; PMCID: PMC12134096.