Does a percutaneous tracheostomy have a lower incidence of complications compared to an open surgical technique?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was which method of tracheostomy had fewer complications, the surgical or percutaneous technique. A total of 264 papers were identified of which 13 provided the best evidence to answer the question. The author, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. We conclude that both percutaneous and surgical tracheostomy have overall a low incidence of complications. There is a lower incidence of procedural complications when inserted surgically. There is a lower incidence of post-procedural complications when inserted via the percutaneous route.