Purpose <p>To estimate the incidence and causes of unplanned acute care revisits after pediatric tonsillectomy and to describe patterns of postoperative healthcare utilization.</p> Methods <p>PubMed, Embase, and the Cochrane Library were searched from inception to February 22, 2026. Studies reporting emergency department (ED) visits, hospital readmissions, reoperations, or overall revisits after pediatric tonsillectomy with or without adenoidectomy were included. Random-effects meta-analyses were performed to estimate pooled incidence rates. Sensitivity analyses were conducted using a leave-one-out approach.</p> Results <p>Twenty-three studies including 1,526,959 pediatric patients were analyzed. The pooled 30-day overall revisit rate was 10.2% (95% CI: 8.1–12.6%). The pooled ED visit rate was 7.8% (95% CI: 6.0–9.9%), while the pooled hospital readmission rate was 3.7% (95% CI: 2.3–5.5%). Reoperation was less common, with a pooled rate of 1.0% (95% CI: 0.5–1.9%). Three studies reported 14-day outcomes, showing a pooled revisit rate of 7.9%. Bleeding accounted for 34.0% of revisits and was the leading cause of readmission, whereas dehydration-related complaints and pain were more commonly associated with ED visits. In subgroup analyses stratified by geographic region (North America vs other regions), pooled ED visit and overall revisit rates were similar across regions, with no statistically significant subgroup differences.</p> Conclusion <p>Unplanned acute care revisits after pediatric tonsillectomy remain relatively common. Most revisits occur within the first two postoperative weeks and are driven primarily by bleeding, dehydration, and pain. These findings highlight opportunities for improving perioperative management and postoperative guidance to reduce avoidable healthcare utilization.</p>