ArticleSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2026
Early enteral feeding following flap surgery for head and neck defects: a quality improvement project using the Plan-Do-Study-Act cycle.
Article in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposePatients 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.
methodsA 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.
resultsForty-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).
conclusionThis 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.
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