Harnessing the power of nature in surgery: A systematic scoping review of nature prescribing and measures of benefit.

Abstract

Natural environments can reduce stress and benefit overall health and nature prescriptions may be a useful adjunct for postoperative care in surgical patients. We sought to identify characteristics and health measures of nature prescriptions in surgery. We undertook a scoping review of 5 bibliometric databases (to February 2024) and citations of peer-reviewed original studies examining nature prescription interventions in patients undergoing major surgical procedures requiring anesthesia and hospital admission. Standardized data extraction and narrative synthesis were performed. The search found 2,175 deduplicated eligible records and 20 full-texts for screening. Ten studies were included and covered auditory (n = 3), visual (n = 3), experiential (n = 3), or mixed interventions (n = 1), with small sample sizes (median, 106; interquartile range, 252). About 50% focused on cardiothoracic surgical patients. Interventions varied from viewing plants/trees, listening to bird/water/forest sounds or being physically immersed. Nearly all included studies reported patient-reported outcome measures (eg, anxiety, pain or mood) that significantly improved across all intervention types. Cardiovascular (eg, heart rate, blood pressure) and respiratory (eg, respiratory rate, vital capacity) outcomes were frequently measured, with greater improvements observed in the nature-based intervention groups compared with controls. Few included studies assess other clinical measures (eg, mortality, length of stay, complications) and only 2 evaluated medications to show reductions in the amount of analgesic consumption after being exposed to nature interventions. Nature prescribing in surgery appears diverse and shows promise for improving postoperative recovery and well-being through reduced anxiety, pain, cardiorespiratory stress, medication use, and improved mood. Medical and research attention to include nature-based therapy in surgery seems warranted.