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STUDY DESIGN This is a retrospective cohort study. OBJECTIVE To evaluate the results of patients operated for chronic coccydynia, and determine any factors that could affect outcomes. SUMMARY OF BACKGROUND DATA Patients with coccydynia who do not respond to conservative treatment will often profit from coccygectomy. Studies of results and complications vary considerably and often report on a limited number of patients. METHODS 184 patients were operated with coccygectomy in our department and followed-up with questionnaires after a minimum of one year post-operatively. Treatment results were compared to their pre-operative state, and any complications or re-operations were recorded and analysed. RESULTS 171 patients (93%) responded to final follow-up. The overall success rate was 71%, defined by patients being either completely well or much better at final follow-up. Furthermore, 89% off all patients would have consented to the operation if they had known the outcome in advance. The rate of post-operative infections was reduced from 10% to 2% by increasing the duration of prophylactic postoperative antibiotics from 24 to 48 hours (p = 0.018). CONCLUSION Coccygectomy, for patients where conservative measures have failed, seems to give acceptable levels of success and high levels of patient satisfaction. The main complication after this procedure is infection, and the risk can be somewhat reduced by using antibiotic prophylaxis for 48 hours after surgery.Level of Evidence: 4.