Main Theme: General
Introduction: BAPO 2024 guidelines for day-case paediatric tonsillectomy stratify patient selection by age, weight, co-morbidities and distance from an emergency ENT centre, recommending residence within a 45-minute radius. Serving a large, predominantly rural population of north-east Scotland, NHS Grampian does not strictly apply this travel-time criterion, aiming to provide equitable care to remote populations.
Methods: Retrospective review of all paediatric patients undergoing tonsillectomy or adenotonsillectomy at Royal Aberdeen Children's Hospital between January 2024 and December 2025. Complications, post-operative bleeding, readmission and return-to-theatre were recorded and stratified by day-case status and travel time, defined by distance from home postcode to hospital.
Results: 585 patients underwent surgery, 20% had a recorded complication, with post-operative bleeding in 10.4% and return-to-theatre in 1.7%. 511 (87%) were managed as day-cases, with lower complication rates than non-day-cases (17.6% vs 36.5%; p<0.001). Within the day-case cohort, 193 (38%) lived beyond 45 minutes from the hospital. These patients had lower rates of any complication (15% vs 19.2%), post-operative bleeding (8.8% vs 11%) and readmission (10.9% vs 14.8%); no difference reached statistical significance. The distance groups were well matched for age, weight, co-morbidity and surgical indication, despite greater travel in the ≥45-minute group (mean 43.2 vs 8.7 miles), supporting comparison validity.
Conclusions: NHS Grampian's complication rates are consistent with national benchmarks, and living beyond 45 minutes from hospital was not associated with increased complications or undue harm. Where robust pre-assessment screening and post-operative pathways exist, distance alone should not be an absolute barrier to day-case tonsillectomy.