Practical Approaches to Balancing Music and Safety in the Operating Room: A Systematic and Narrative Review.

Background: Music in the operating room (OR) reduces stress and improves focus and team performance. It can also distract the team, increase miscommunication, and threaten patient safety. Previous work has characterized these pros and cons eloquently, yet no cohesive guideline to manage OR music responsibly exists to date. Here, a practical framework for OR music that reduces risks and maximizes benefits is proposed. Methods: Both scoping and systematic quantitative review guidelines, including Preferred Reporting Items for Systematic Reviews and Meta-Analyses, were queried using search terms to identify the effects of OR music on surgical teams and whether existing regulatory guidelines were available. Results: Fourteen studies met the inclusion criteria for the systematic review, including randomized/crossover trials (29%), controlled nonrandomized studies (14%), observational studies (43%), and cross-sectional surveys (14%). Across these, surgeon-directed music was associated with improved mood, reduced stress, and greater perceived efficiency, whereas team-level outcomes showed mixed effects, with 9 of 14 studies (64%) reporting impaired communication, distraction, or reduced situational awareness. No study provided a formal guideline for OR music management beyond general suggestions, such as low volume and instrumental selections. Conclusions: Managing OR music is necessary to maintain patient safety, and doing so using grassroots principles, starting with team involvement, could provide a better and more sustainable solution.