Recent national guidelines have highlighted the safety of day-case tonsillectomy. This study evaluates the outcomes of paediatric tonsillectomy at a UK tertiary centre during the COVID-19 pandemic. A retrospective analysis was conducted on patients <18 years who underwent tonsillectomy between April 2021-September 2022. Data on post-operative events until discharge and re-attendance within 14 days were recorded. High-risk subgroups were analysed: Subgroup A (aged 2 and weighing 12-15 kg) and Subgroup B (severe OSA on polysomnography). Binary logistic regression assessed whether age, weight, sex, or procedure time predicted extended hospital stay (>1 night) or need for oxygen. A total of 117 patients underwent tonsillectomy, median age 4 (62% male). OSA/SDB accounted for 88% and 68% had a pre-operative sleep study. Same-day discharge rate was 26%. Post-operatively, 86 patients were admitted; 44 required overnight oxygen saturation monitoring, 35 for weight extremes and 7 for poor oral intake. Of those admitted, 70 (81%) remained well overnight, and 76 patients (88%) were discharged the next day. In Subgroup A (n=17), average weight was 13.4 kg; two had transient desaturations. Fourteen were discharged the next day. In Subgroup B (n=34), four had transient desaturations with a further two requiring oxygen. Weight (p=0.071) and procedure time (p=0.052) approached significance for predicting outcomes. This study offers early insights into paediatric tonsillectomy outcomes during the COVID-19 pandemic at a tertiary centre. Although the same-day discharge rate was lower than the national average, most patients, including high-risk groups, remained clinically stable and were discharged within 24 hours.