Background: Tonsillectomy is one of the most common surgical procedures around the world, with over 500,000 cases done annually. There are various reported complications, the most serious complication is post-tonsillectomy bleeding accounting for 1.6- 5.6%. Post tonsillectomy bleeding can be either primary occurring in the first 24 hours or secondary bleeding occurring beyond first 24 hours. The aim of study is to evaluate and analyze risk factors of secondary post tonsillectomy bleeding in Saudi Arabia. Methodology: This is a retrospective study, included all patient whom underwent tonsillectomy from Jan 2020 to May 2024. All patients charts were reviewed, and 26 variables were extracted from patients who developed secondary post tonsillectomy bleeding. Results: A total of 977 patients underwent tonsillectomy, 3.89% of patients developed secondary post tonsillectomy bleeding and 2.14% underwent secondary surgery to arrest the bleeding with male predominance accounting for 60.5%. Furthermore, age and gender has been significantly associated with increased risk of post tonsillectomy bleeding Conclusion: Incidence of secondary post tonsillectomy bleeding account for 3.89%. Not all cases required secondary surgical intervention for arrest of bleeding.

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