The impact of early oral feeding following head and neck free flap reconstruction on complications and length of stay

Kerawala, Cyrus; Riva, Francesco; Paleri, Vinidh

doi:10.1016/j.oraloncology.2020.105094

Cited by 18 publications

(42 citation statements)

References 14 publications

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“…In keeping with the existing literature, our cohort of 29 patients were found to have a shorter hospital stay with a median of 10 days in comparison to historical cohorts at our centre; where in the delayed feeding group, the average length of stay was 20.6 days [5]. Minor post-operative complications were noted with three patients who experienced small orocutaneous fistulae, which spontaneously resolved with medical treatment (antibiotics) and a period of NBM status.…”

Section: Discussionsupporting

confidence: 79%

“…Historically, it has been thought that early oral post-operative feeding increases the potential for an orocutaneous fistula to develop and therefore surgeons have traditionally adopted a conservative approach and kept patients ‘nil by mouth’ (NBM) for up to 12 days following surgical resection with free flap reconstruction for oral cancer [ 5 ]. It has been conceptualised that overuse of the oral mechanism/pharynx in the early post-operative phase places excessive stress on the interface between the flap reconstruction and the mucosa leading to dehiscence and potentially the formation of a secondary fistula into the neck [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…A more recent large prospective cohort study included 400 patients. Two cohorts were compared including patients who remained NBM for 5 days post-surgery (‘late feeding group’) and those who commenced oral intake on day 1 post-surgery (‘early feeding group’) [ 5 ]. Two hundred patients were included in each group.…”

Section: Introductionmentioning

confidence: 99%

“…Complications at the recipient site were noted in 8% of patients but no difference was observed in the rates of flap dehiscence (4–5%) or fistula formation (4%) between the two groups. Early feeding was associated with a statistically reduced length of hospital stay (mean 11.6 days vs 20.6 days, p < 0.01) [ 5 ]. It was unclear from this study the nature/type of feeding protocol used or the presence or nature of SLT input.…”

Section: Introductionmentioning

confidence: 99%

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Early Post-operative Feeding: An Investigation of Early Functional Outcomes for Oral Cancer Patients Treated with Surgical Resection and Free Flap Reconstruction

et al. 2021

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Traditionally patients can remain nil by mouth (NBM) for up to 12 days after oral tumour resection with free flap reconstruction to reduce the risk of flap dehiscence, poor healing and fistulae. The literature reports that patients could on average remain an inpatient for up to 20 days post-surgery. An evaluation of the impact of a defined early oral feeding protocol was undertaken investigating functional outcomes and complications rates. We prospectively reviewed tracheostomy use, length of hospital stay, non-oral feeding status and swallowing function using the Performance Status Scale for Head and Neck Cancer (PSS-HN) within a defined early feeding protocol. Twenty-nine patients underwent surgical resection with free flap reconstruction for advanced primary oral cancer between January 2018 and December 2019. Average age was 59.5 (range 24–88). Tumour sites included oral tongue (n = 10), maxilla (n = 6), mandible (n = 6), floor of mouth (n = 5) and buccal mucosa (n = 2). Median time to decannulation was 7 days (range 3–20 days, n = 11). The majority of patients were able to tolerate at least oral fluids on day 1 post-operatively (86%, n = 25). In addition to oral intake, non-oral feeding was required in 90% (n = 26), the majority of which included a nasogastric tube (NGT) placed intraoperatively 54% (n = 14), others required gastrostomy 46% (n = 12). Median time to nasogastric tube removal was 6 days (range 3–15 days). Median length of hospital stay was 10 days (range 3–51). Mean PSS-Normalcy of Diet (NOD) score at point of hospital discharge was 36.55 (95% CI 30.9–42.2). Flap failure was noted in 3% (n = 1). The adoption of an early oral feeding protocol suggests that there is the potential for a shorter hospital stay and earlier swallowing rehabilitation.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early Post-operative Feeding: An Investigation of Early Functional Outcomes for Oral Cancer Patients Treated with Surgical Resection and Free Flap Reconstruction

et al. 2021

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“…These benefits include a decreased length of stay and improved quality of life [72,73] . Furthermore, weak evidence supports early oral intake as a mechanism to preserve muscle memory associated with swallowing [74] . Historically, however, head and neck services have hesitated to start an oral diet on the first postoperative day (POD-1) out of concern that overuse of the tongue and pharynx could increase the risk of wound dehiscence and fistula formation in the aerodigestive tract.…”

Section: Early Diet Initiationmentioning

confidence: 99%

Enhanced recovery and medical management after head and neck microvascular reconstruction

Gidumal¹,

Worrall²,

Phan³

et al. 2021

PAR

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Protocols to enhance and expedite recovery after surgery originally developed through efforts in gastrointestinal, colorectal, and thoracic surgery populations. Implementation of specific evidence-based interventions undertaken in the perioperative setting has been shown to decrease the length of stay, reduce cost, and improve patient outcomes and satisfaction. The basic tenets of enhanced recovery protocols are to reduce physiologic stress in the perioperative setting, improve nutritional status before and after surgery, promote respiratory and physical rehabilitation, and encourage frequent and recurring reassessment for quality improvement. Some interventions, such as the use of deep vein thrombosis prophylaxis in the perioperative setting, are now well established across surgical populations; however, the increased attention to these protocols has led to new innovative interventions in the head and neck population. This review highlights these innovative interventions designed to enhance recovery after major surgery, lends particular focus to the biological mechanisms behind these interventions, and describes their relevance to the head and neck population.

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Early feeding after free flap reconstruction of the oral cavity: A systematic review and meta‐analysis

Barlow,

Sragi,

Rodriguez

et al. 2024

Head & Neck

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BackgroundTraditionally, patients undergoing free flap reconstruction for oral cavity defects have been given nothing by mouth for 6–14 days post‐operatively due to concern for orocutaneous fistula development.MethodsMultiple databases were screened for studies assessing the rate of orocutaneous fistula formation in early (≤5 days) versus late (>5 days) feeding groups following oral cavity free flap reconstruction. Fixed‐ and random‐effects meta‐analyses were used.ResultsOne randomized controlled trial, one prospective cohort, and three retrospective cohort studies were included. The early feeding group displayed no significant increase in orocutaneous fistula formation (RD = −0.02, p = 0.06) or free flap failure (RD = −0.01, p = 0.39), with a significantly shorter hospital length of stay (mean difference [days] = −2.43, p < 0.01).ConclusionsWhile further prospective trials are necessary, initiation of oral intake before post‐operative day 5 may be appropriate in properly selected patients following oral reconstruction.

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The impact of early oral feeding following head and neck free flap reconstruction on complications and length of stay

Cited by 18 publications

References 14 publications

Early Post-operative Feeding: An Investigation of Early Functional Outcomes for Oral Cancer Patients Treated with Surgical Resection and Free Flap Reconstruction

Early Post-operative Feeding: An Investigation of Early Functional Outcomes for Oral Cancer Patients Treated with Surgical Resection and Free Flap Reconstruction

Enhanced recovery and medical management after head and neck microvascular reconstruction

Early feeding after free flap reconstruction of the oral cavity: A systematic review and meta‐analysis

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