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Effects of Art on Surgical Patients: A Systematic Review and Meta-analysis

Vetter, Diana MD*; Barth, Jürgen PhD; Uyulmaz, Sema MD*; Uyulmaz, Semra MD*; Vonlanthen, René MD*; Belli, Giulio MD; Montorsi, Marco MD§; Bismuth, Henri MD; Witt, Claudia M. MD, MBA†,||; Clavien, Pierre-Alain MD, PhD, FACS (Hon)*,¶

doi: 10.1097/SLA.0000000000001480
Special ESA Lecture 2015

Objectives: The aim of the study was to assess the effect of art including ambient features such as music, interior design including visual art, and architectural features on health outcomes in surgical patients.

Background: Healing environments can have a positive influence on many patients, but data focusing on art in surgical patients remain scarce.

Methods: We conducted a systematic search following the PRISMA guidelines from January 2000 to October 2014 on art in surgical patients. For music interventions, we pooled controlled studies measuring health outcomes (eg, pain, anxiety, blood pressure, and heart rate) in a meta-analysis. For other art forms (ambient and architectural features and interior design), we did a narrative review, also including nonsurgical patients, and looked for examples covering 3 countries.

Results: Our search identified 1101 hits with 48 studies focusing on art in surgical patients: 47 studies on musical intervention and 1 on sunlight. The meta-analysis of these studies disclosed significant effects for music on pain after surgery, anxiety, systolic blood pressure, and heart rate, when compared with control groups without music. Effects of music were larger with self-selected music, and lower in surgical interventions performed under general anesthesia. Interior design features such as nature images and more spacious rooms, and architectural features providing more sunlight had positive effects on anxiety and postoperative pain.

Conclusions: Self-selected music for surgical patients is an effective and low-cost intervention to enhance well being and possibly faster recovery. Although potentially very important, the impact of environmental features and spacious architecture with wide access to sunlight remains poorly explored in surgery. Further experimental research is needed to better assess the magnitude of the impact and cost effectiveness.

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*Department of Surgery, University Hospital and University of Zurich, Zurich, Switzerland

Institute for Complementary and Integrative Medicine, University Hospital and University of Zurich, Zurich, Switzerland

Department of Hepatopancreaticobiliary Surgery, Ospedale S. Maria di Loreto Nuovo, Naples, Italy

§Humanitas Research Hospital and University, Milan, Italy

Hôpital Paul Brousse, Université Paris Sud, Paris, France

||Institute for Social Medicine Epidemiology and Health Economics, Charité Universitätsmedizin, Berlin, Germany.

Reprints: Pierre-Alain Clavien, MD, PhD, Department of Surgery, University Hospital of Zurich and University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland. E-mail:

First and second author contributed equally.

Grant support: The study was supported by Liver and Gastrointestinal Disease Foundation (

Disclosures: The authors have nothing conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.