{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:46:58Z","timestamp":1792090018710,"version":"4.4.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Support Care Cancer"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Patients undergoing reconstructive head and neck (H&amp;N) surgery are often made nil-by-mouth postoperatively, requiring enteral feeding. Early enteral feeding (\u2264\u200924\u00a0h) after surgery is recommended as part of enhanced recovery. Limited literature has investigated timing to enteral feeding in H&amp;N.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013Whitney for continuous data and Fisher\u2019s exact for categorical data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty-five patients were included (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200923 EEN,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200922 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\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), time to commencing EN (median [Q1, Q3]: 4.3 [3.3, 5.7] vs 18.5 [17.4, 19.9] hrs\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) feed in first 24\u00a0hrs (215\u00a0ml vs 0\u00a0ml\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.001), energy (322.5\u00a0kcal vs 0\u00a0kcal\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) protein intake (13.5\u00a0g vs 0\u00a0g\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and weight loss (median 1% vs 5.6%\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). No statistically significant differences were observed between Clavien-Dindo (grade\u2009\u2265\u20093 35% EEN vs\u00a027% UEN,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.92), or length of stay (13\u00a0days vs 14.5\u00a0days\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.92).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00520-026-11231-7","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:51:18Z","timestamp":1790139078000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early enteral feeding following flap surgery for head and neck defects: a quality improvement project using the Plan-Do-Study-Act cycle"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7405-6080","authenticated-orcid":false,"given":"Florence","family":"Cook","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelie","family":"Niemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5322-7327","authenticated-orcid":false,"given":"Gareth","family":"Ambler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5969-0208","authenticated-orcid":false,"given":"Axel","family":"Sahovaler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Ward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"issue":"4","key":"11231_CR1","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1097\/00006534-197610000-00003","volume":"58","author":"T Harashina","year":"1976","unstructured":"Harashina T, Fujino T, Aoyagi F (1976) Reconstruction of the oral cavity with a free flap. 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Ethical approval was not required in accordance with the Health Research Authority decision tool (\n                      \n                      ) as this was considered service improvement\/audit.","order":1,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was not required for use of the data in this quality improvement project. Patients who had signed for UK NHS data opt-out were excluded in accordance with data protection regulations.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1008"}}