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Program Number: B291
Session Name: Poster Session

Early Oral Feeding Does Not Increase Postoperative Complications in Microvascular Reconstruction

James A Stewart, MD¹; Sarai Robertson, BS²; Nicolaus D Knight, MS¹; Duane Trahan, MS, SLPCCC¹; Caitlin D Stone, MCD, SLPCCC¹; Melissa T Ponto, MS, SLPCCC¹; Benjamin Greene, MD¹; Kirk Withrow, MD¹; Susan McCammon, MD, PhD¹; Carissa M Thomas, MD, PhD³; ¹Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham; ²Heersink School of Medicine, University of Alabama at Birmingham; ³Department of Otolaryngology - Head and Neck Surgery, University of Colorado

Background: Microvascular free flap reconstruction for head and neck defects are major surgeries with high risk of complications. Historically, patients were subjected to prolonged periods of nil per os (NPO) to promote wound healing and decrease rates of postoperative complications such as oro or pharyngocutaneous fistulas and wound dehiscence. There is little evidence in the literature supporting this practice, and prolonged NPO is associated with decreased quality of life, difficulty swallowing, and malnutrition.1,2 Early oral feeding is defined as oral intake within the first five days of surgery and could mitigate the morbidity of prolonged NPO.3-5 The safety of early oral feeding remains in question, however.

Objective: To determine if early oral feeding significantly changes the rates of postoperative complications in patients undergoing microvascular free flap reconstruction for head and neck defects.

Methods: A retrospective (08/19/2019-07/31/2023) and prospective (08/01/2023-09/13/2024) cohort study was done on patients undergoing microvascular free flap reconstruction for mucosal-based defects by a single reconstructive surgeon. Early oral feeding protocols were instituted 08/01/2023 for all patients and included initiation of oral intake on postoperative day (POD) 3 and 5 for soft tissue and osteocutaneous reconstructions respectively. Data collection included demographics, medical comorbidities pertinent to wound healing, free flap type, and hospital length of stay (LOS). Information on water soluble esophagram (WSE) timing and result, fistula, wound dehiscence, and 30-day readmission rates was collected. All patients were evaluated by a speech language pathologist (SLP) and discharge diet per SLP recommendations was recorded. Data analysis was done in R studio. Pearson Chi-Squared test or Fischer Exact test (categorical variables) and Student t test or Mann-Whitney (continuous variables) were used to compare early oral feeding to delayed feeding. Significance was defined as p<.05.

Results: A total of 157 patients were included in the delayed oral feeding cohort and 46 in the early oral feeding cohort. There was no significant difference in age, body mass index (BMI), sex, race, smoking and alcohol status, diabetes, hypothyroidism, diagnosis (cancer versus non-cancer), stage, type of reconstruction, and prior treatment between the cohorts. Early oral feeding demonstrated no significant difference in fistula rate, incidence of leak on WSE, wound dehiscence, and 30-day readmission rates. There was no change in hospital LOS between cohorts. Significantly more patients were discharged with a diet versus NPO in the early oral feeding cohort (p<.004). Table 1

Conclusion: Early oral feeding appears to be safe with no increase in postoperative complications. Most patients are able to take some form of PO at the time of discharge after SLP evaluation. Additional research is necessary to define ideal timing and diet as well as the impact on malnutrition, swallowing, and quality of life.

Table 1. Postoperative Outcomes Based on Oral Feeding Status

 

 

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