Preventing Nasal Alar Necrosis in Oral Cancer Patients: A Quality Improvement Initiative for Safer Nasotracheal Intubation at a Tertiary Cancer Centre

Abstract Nasal alar necrosis (NAN) is a known but easily avoidable complication of nasal intubation in patients undergoing head And neck cancer surgery. It is preventable, And the presence of NAN can be considered a poor quality of service rendered to the patients. This study was done as part of the quality control aspect in the institution. The aim was to sensitise the stakeholders to the existence And identification of this problem, identify factors predisposed to the development of NAN, And act on them to reduce its incidence in the hospital. A total of 141 patients were operated on between 1st Oct 2023 And 31st Dec 2023, of which 77 patients had nasotracheal intubation. The incidence of NAN was seen in 28 patients (36.4%). The factor predisposing to the development of NAN was overnight intubation ( p < 0.001). Twenty-seven out of the 28 patients with overnight intubation developed AnN. Various key drivers were identified, And interventions were introduced in January. The incidence of NAN was subsequently recorded fortnightly, like before, till May 15th 2024. The incidence reduced over time to 7% from the initial 36.4%. NAN is a preventable postoperative complication in patients undergoing head and neck surgery with nasotracheal intubation. Constant effort is needed to monitor its incidence and sustain the factors implemented to prevent this complication.