Music to prevent deliriUm during neuroSurgerY (MUSYC): a single-centre, prospective randomised controlled trial

BMJ Open · 12 authors, 7 centres

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TL;DR

This randomised controlled trial tested whether playing preferred music before, during, and after craniotomy reduces postoperative delirium.

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This single-centre, prospective randomised controlled trial enrolled 189 adult patients undergoing craniotomy to evaluate if music therapy reduces postoperative delirium. The intervention group received preferred recorded music before, during, and after surgery. The primary outcome was delirium incidence within the first 5 postoperative days, first screened with the Delirium Observation Screening Scale (DOSS) and then confirmed by a psychiatrist using DSM-5 criteria. Delirium was less common in the music group according to DOSS (11.6% vs 22.3%), but the difference was not statistically significant after DSM-5 confirmation (4.2% vs 7.4%). Music significantly increased preoperative heart rate variability (RMSSD). The study was not blinded, and the follow-up adherence to the music intervention declined postoperatively.

STUDY TYPE

RCT

SPECIALTY

surgery

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10410844

Music to prevent deliriUm during neuroSurgerY (MUSYC): a single-centre, prospective randomised controlled trial

BMJ Open

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ABSTRACT

Objectives Delirium is a serious complication following neurosurgical procedures. We hypothesise that the beneficial effect of music on a combination of delirium-eliciting factors might reduce delirium incidence following neurosurgery and subsequently improve clinical outcomes. Design Prospective randomised controlled trial. Setting Single centre, conducted at the neurosurgical department of the Erasmus Medical Center, Rotterdam, the Netherlands. Participants Adult patients undergoing craniotomy were eligible. Interventions Patients in the intervention group received preferred recorded music before, during and after the operation until day 3 after surgery. Patients in the control group were treated according to standard of clinical care. Primary and secondary outcome measures Primary outcome was presence or absence of postoperative delirium within the first 5 postoperative days measured with the Delirium Observation Screening Scale (DOSS) and, in case of a daily mean score of 3 or higher, a psychiatric evaluation with the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Secondary outcomes included anxiety, heart rate variability (HRV), depth of anaesthesia, delirium severity and duration, postoperative complications, length of stay and location of discharge. Results We enrolled 189 patients (music=95, control=94) from July 2020 through September 2021. Delirium, as assessed by the DOSS, was less common in the music (n=11, 11.6%) than in the control group (n=21, 22.3%, OR:0.49, p=0.048). However, after DSM-5 confirmation, differences in delirium were not significant (4.2% vs 7.4%, OR:0.47, p=0.342). Moreover, music increased the HRV (root mean square of successive differences between normal heartbeats, p=0.012). All other secondary outcomes were not different between groups. Conclusion Our results support the efficacy of music in reducing the incidence of delirium after craniotomy, as found with DOSS but not after DSM-5 confirmation, substantiated by the effect of music on preoperative autonomic tone. Delirium screening tools should be validated and the long-term implications should be evaluated after craniotomy. Trial registration number Trialregister.nl: NL8503 and ClinicalTrials.gov: NCT04649450 .

CITATION EXPORT

Pablo R Kappen, M I Mos, Johannes Jeekel et al.. Music to prevent deliriUm during neuroSurgerY (MUSYC): a single-centre, prospective randomised controlled trial. BMJ Open. (2023). https://doi.org/10.1136/bmjopen-2022-069957

AUTHORS

12 · 7 CENTRES

Pablo R Kappen, M I Mos, Johannes Jeekel, Clemens M F Dirven, Steven A Kushner, Robert-Jan Osse, Michiel Coesmans, Marten J Poley, Mathijs S van Schie, Bronno van der Holt, M Klimek, Arnaud J P E Vincent

1 Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
2 Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
3 Institute for Medical Technology Assessment (iMTA), Erasmus Medical Center, Rotterdam, The Netherlands
4 Department of Paediatric Surgery and Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
5 Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
6 Department of Haematology, Erasmus Medical Center, Rotterdam, The Netherlands
7 Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands