Timing of oral feeding following head and neck mucosal free flap reconstruction - A systematic review and meta-analysis.

[BACKGROUND] Timing of oral feeding following head and neck mucosal free-flap reconstruction is a highly contentious issue. The typical 6-12 days "nil-by-mouth' primarily revolves around the concern for post-operative complications. Conversely, early feeding has been shown to reduce the patient's stress response, optimise physiological function, and facilitate recovery and healing. Nevertheless, the optimum time of oral feeding is unknown, and the impact of early feeding on post-operative complications and length of hospital stay (LOS) remains controversial.

[METHODS] A systematic review was conducted across the databases; Medline (Pubmed), EMBASE, Cochrane Central, and Scopus for studies comparing the outcomes of early (≤5 days) and/or late (>5 days) oral feeding following reconstructive head and neck surgery involving mucosal free-flaps. Fixed and random-effects meta-analyses were utilised.

[RESULTS] The search yielded 1283 articles, of which thirteen met the inclusion criteria, encompassing a total of 1657 patients. Early feeding was significantly associated with lower risk of fistulas (3.66% vs 11.35%) (RR 0.37, 95%CI 0.22 to 0.64; P = 0.0004) and lower risk of pneumonia (6.31% vs 12.38%) (RR = 0.53, 95%CI 0.33 to 0.87; P = 0.011) compared to late feeding. Early feeding significantly reduced LOS compared to late feeding (x̄=9.85 vs 13.11 days) (MD -4.10, 95%CI -7.07 to -1.14; P=0.0067). The incidence of flap-failure, haematoma and dehiscence was similar between the two groups.

[CONCLUSIONS] Early oral feeding initiation appears to be safe and associated with improved or similar patient outcomes and reduced LOS. Surgeons should consider early oral feeding in a carefully selected population.