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Tonsillectomy remains a common procedure in adults; however, there are few population-level data evaluating risk factors for reoperation.Retrospective review of national database.American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2013.The ACS-NSQIP was queried for patients undergoing tonsillectomy ± adenoidectomy as their primary procedure (CPT 42821 or 42826). Demographic information and indications were reviewed along with complications and reoperation rates.In total, 12,542 cases met inclusion criteria. Patients were predominantly female (66.4%) and white (70.8%), with mean age of 30 ± 12 years (range: 16-90+). Thirty-day mortality was 0.03%, and 4.8% of patients experienced at least 1 complication, including reoperation (3.6%). Risk of complications was associated with male sex (P < .0001; odds ratio [OR], 1.7), diabetes (P = .0002; OR, 2.1), and presence of a bleeding disorder (P = .002; OR, 3.2). Risk factors for reoperation were similar, in addition to older age (P = .002; OR, 0.986). Complications other than reoperation were correlated with older age (P = .001; OR, 1.02) and diabetes (P = .001; OR, 2.59). Procedures were done mostly for infectious/inflammatory (70.4%) versus hypertrophic (16.4%) indications. Indication had no significant effect on the rate of reoperation. Most reoperations occurred after postoperative day 1 (86%; mean, 6.4 ± 4.2 days).This review of a large validated surgical database provides an overview of the rates of, and risk factors for, complications and reoperations following tonsillectomy in the adult population.