Background: Northern Ireland has the highest level of childhood obesity in primary 1 children in the UK. Updated BAPO guidance recommends overnight admission for paediatric patients weighing >98th centile undergoing adenotonsillectomy due to perceived historical respiratory risks. Utilising coblation techniques and bespoke opioid-sparing anaesthesia may safely facilitate day-case selection in conjunction with GIRFT guidelines. This study evaluated the safety, efficacy, and success rates of day-case intracapsular adenotonsillectomy in this unique cohort.
Methods: A retrospective, single-institution review in Belfast analysed data from 99 paediatric patients (>98th weight centile) over a two-year period from August 2024. Monitored parameters included weight, z-scores, co-morbidities, pre-operative sleep studies, and 28-day surgical complications or re-admissions.
Results: The cohort averaged 9 years old and 56.3kg in weight (range: 16.9–108kg; mean z-score: 2.72, range: 1.78–4.86). Minor respiratory complications occurred in 5% of patients (5/99), requiring only brief supplemental oxygen or transient need for an oropharyngeal airway; no major or additional inpatient respiratory complications occurred. The overall day-case rate reached 86%, with 22/36 planned admissions successfully converted to day-cases. Overall saving of 85 bed days. Overnight admission was required for 14 patients, 11 of whom had significant co-morbidities. Secondary haemorrhage occurred in 1%, and unrelated re-admissions occurred in 5%.
Conclusion: A weight >98th centile is not an absolute contraindication for day-case adenotonsillectomy when using a meticulous intracapsular technique and opioid-sparing anaesthesia in high-acuity centres. Risk stratification utilising a z-score <3 and the absence of co-morbidities achieves an optimal day-case rate with exclusively minor, post-operative respiratory complications.