Perceptions On Music And Noise In The Operating Room: A Cross Sectional Study

1. Introduction

High noise levels in the operating rooms (ORs) during surgery may pose a major threat to the safety and efficiency of procedures performed [1]. The recommended threshold for noise should not exceed 90 dBA over an 8 hour period to prevent noise induced hearing loss [2]. Unfortunately, in 40% of surgeries, OR noise levels reach and exceed 100-120 dBA [2], comparable to a busy highway (1). High noise levels affect both patients and staff: patients may suffer from intraoperative hypertension and tachycardia [3], and prolonged exposure of staff to OR noise has been linked to noise induced hearing loss [4,5], to interference with communication in the OR (6) and to decrements in surgeons' concentration and vigilance [4,7,8].

Sources of noise in the OR stem primarily from (a) surgical instruments including high speed pneumatic drills, chisels, hammers, and saws [9], (b) equipment such as vital sign monitors, alarms, ventilators, anesthesia machines, waste management devices, and radiological equipment [6] and (c) conversations amongst the staff [4]. Clanging, clattering or dropping metal instruments is also another source of noise [1]. In addition to the above, music is occasionally played in ORs, often requested and chosen by the operating surgeon; whether music qualifies as just more noise is debatable [5]. There have been mixed reports on the effect of music on personnel performance, concentration, communication, speed and cooperation [8, 10-16]. Proponents of music claim that it masks some of the noise, has a calming effect, improves motivation, increases accuracy, and reduces stress [1, 11, 12, 14, 15, 17]. A review of the literature describes the effect of music as contributing to overall stress of the environment, interfering with communication, and posing a threat to the safety of patient and staff as well as to task completion [5].

The literature is lacking in research on the effects of music as a distractor during operations, especially given the likelihood of unexpected stressful intraoperative complications [18]. It is not clear if at a critical time in a race against the clock, music incentivizes the surgeon and OR staff or if it exacerbates their stress and distracts them.

Our aim was to determine how surgeons, anesthesiologists, residents and nurses perceived the presence of noise and music in the operating room and how they thought it affected their performance, concentration and communication. The results of this study will guide the design of a follow up study to determine the effects of music on outcomes of specific procedures. 2. Material and Methods 2.1 Study design and setting: