Discussion
delirium, postoperative delirium, DSM-5, anxiety
POSTOPERATIVE COMPLICATIONS
We found a significant decrease on the incidence of postoperative delirium by the addition of music perioperatively using the DOSS; however, this was not significant when assessed by the DSM-5 criteria. Second, music activated preoperative HRV, a marker of autonomic tone. Last, no significant effects on anxiety, depth of anaesthesia, postoperative complications, length of stay and location of discharge were found. Clinical implications and limitations are discussed below.We found a significant decrease on the incidence of postoperative delirium, defined with DOSS, by the addition of perioperative music. A recent published systematic review conducted a meta-analysis on the preventive effect of music on delirium with six studies and found a relative reduction similar to ours (0.52 vs 0.48).We propose a vagal-mediated anti-inflammatory response as a candidate pathway of music on delirium, as hypotheses of delirium rely on neuroinflammatory reactions within the brain.We found high adherence to the music intervention before surgery. High importance of music in daily life, the number of hours listening to music in daily life and the willingness to receive music intervention in case of future surgeries were found in our cohort, which are considered important facilitators for music implementation.Although delirium is (most often) temporary and self-limiting, delirium independently predicts clinically relevant outcomes in neurologically damaged patients.