Early enteral feeding following flap surgery for head and neck defects: a quality improvement project using the Plan-Do-Study-Act cycle

Abstract

Abstract Purpose Patients undergoing reconstructive head and neck (H&N) surgery are often made nil-by-mouth postoperatively, requiring enteral feeding. Early enteral feeding (≤ 24 h) after surgery is recommended as part of enhanced recovery. Limited literature has investigated timing to enteral feeding in H&N. Methods A quality improvement project was undertaken at a London network guided by the Plan-Do-Study-Act cycle. Usual care was to wait until the morning review before commencing enteral feeds. A change of approach was queried to bring this forward e.g. same day of surgery. Five consultants agreed to trial earlier enteral nutrition (EEN); two opted to continue with usual care (UEN). Data were collected prospectively on fasting time, nutritional intake and complications. Groups were compared using t-test or Mann–Whitney for continuous data and Fisher’s exact for categorical data. Results Forty-five patients were included ( n = 23 EEN, n = 22 UEN) between May and November 2025. The EEN group had significantly lower average preoperative fasting time than UEN group (median [Q1, Q3]: 0.7 [0.6, 0.9] vs 1.3 [1.2, 1.5] days p < 0.001), time to commencing EN (median [Q1, Q3]: 4.3 [3.3, 5.7] vs 18.5 [17.4, 19.9] hrs p < 0.001) feed in first 24 hrs (215 ml vs 0 ml p ≤ 0.001), energy (322.5 kcal vs 0 kcal p < 0.001) protein intake (13.5 g vs 0 g p < 0.001) and weight loss (median 1% vs 5.6% p = 0.02). No statistically significant differences were observed between Clavien-Dindo (grade ≥ 3 35% EEN vs 27% UEN, p = 0.92), or length of stay (13 days vs 14.5 days p = 0.92). Conclusion This project helps demonstrate proof-of-concept of EEN in a naturalistic setting. Patients receiving EEN had reduced fasting times without increased complications. Providing nutrition in the immediate postoperative period may generate additional benefits, which further research should establish.