title: Effects of Art on Surgical Patients: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  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.
authors.affiliation: *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.
authors.forename: Diana
authors.initials: D
authors.lastname: Vetter
authors.forename: Jürgen
authors.initials: J
authors.lastname: Barth
authors.forename: Sema
authors.initials: S
authors.lastname: Uyulmaz
authors.forename: Semra
authors.initials: S
authors.lastname: Uyulmaz
authors.forename: René
authors.initials: R
authors.lastname: Vonlanthen
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
authors.forename: Henri
authors.initials: H
authors.lastname: Bismuth
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Witt
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
mesh_terms: D001007:Anxiety / Q000517:prevention & control*; D006801:Humans; D009147:Music Therapy / Q000379:methods*; D011300:Preoperative Care / Q000379:methods* / Q000523:psychology; D013514:Surgical Procedures, Operative / Q000523:psychology*