New guidance published for paediatric day case adenotonsillectomy

20 February 2024

The British Association for Paediatric Otolaryngology (BAPO), in collaboration with several organisations including ENT UK, has released new guidance to support surgical units undertaking adenotonsillectomies in children as day cases. This is to support them in achieving the target for day case surgery recommended by NHS England Getting it Right First Time (GIRFT).

Michelle Wyatt, BAPO President 2022-23 said:

All of those involved in treating children wish to provide a safe, efficient service with excellent outcomes alongside the best possible patient and carer experience. Traditionally adenotonsillectomy surgery in children has been viewed as requiring at least an overnight stay post operatively. This was to monitor for bleeding and airway issues and to ensure adequate pain relief was achieved with a return to normal eating and drinking. However, numerous studies have been published showing that same day discharge is safe for the majority and is actually preferred by families. In the current climate there are also cost implications both to the NHS and to patients linked to a prolonged hospital stay. Day case surgery should allow more children to be treated in a timely fashion to help address the backlog for elective procedures which has arisen post COVID.

In 2023 the British Association for Paediatric Otorhinolaryngology (BAPO) was asked to form a working group to produce consensus guidelines for those units undertaking adenotonsillectomy in children. This was to support them in achieving the targets for day case surgery as recommended by the NHS England Getting it Right First Time Programme (GIRFT).

On behalf of BAPO I would like to offer my sincerest thanks to all those clinicians who gave so much of their time to contribute to this valuable document. There was representation from both adult and paediatric ENT surgeons alongside anaesthetic and nursing colleagues. I particularly wish to mention Mat Daniel from Nottingham and Steven Powell from Newcastle, their extensive knowledge of the literature on this subject and strong scientific backgrounds allowed a thorough assessment of the existing evidence on the topic to be made. Simon Courtman from Plymouth was heavily involved from an anaesthetic perspective and Andrew Hoey provided valuable input reflecting his time working with NHS England. Finally, the document would not be available today without Ravi Thevasagayam who, as BAPO secretary, worked tirelessly to get the document over the line.

Read the full guidelines here