OBJECTIVE: The aim of investigation was to reveale whether percutaneous dilatational tracheostomy is faster, cheaper and with less complications in contrast to open surgical tracheostomy. DESIGN: The study was designed as retrospective - cohort study. SETTINGS: The study was carried out at the Department of Otorhinolaryngology, Head and Neck Surgery and the Department of Anesthesiology and Intensive Care Medicine University Hospital Centre Split. PARTICIPANTS: From January 2009 till December 2010, 89 patients had been subjected to percutaneous or open surgical tracheostomy at the Department of Otorhinolaryngology, Head and Neck Surgery and the Department of Anesthesiology and Intensive Care Medicine University Hospital Centre Split. 64 males and 25 females were included in the study. In 36 patients percutaneous dilatational tracheostomy and in 56 patients open surgical tracheostomy was done. MAIN OUTCOME MEASURES: The main outcome measures of the study were appearance of postoperative complications: postoperative infection (isolated bacterias in urine, blood, bronchus aspirates), postoperative bleeding (need for blood transfusion after operation) and postoperative subcutaneous emphysema and pneumothorax on x-ray images. We were also monitoring the operating time to compare which operation is faster to do. RESULTS: Eighty-nine patients were included in the study. Thirty-six patients underwent percutaneous dilatational tracheostomy and 56 patients underwent open surgical tracheostomy. We did not found statistically significant difference in postoperative complications between percutaneous dilatational tracheostomy and open surgical tracheostomy (P<0,05). We found statistically significant difference in operating time (P<0,0001) that is, percutaneous dilatational tracheostomy last shorter and it was much cheaper (15 minutes; 1300 kn) than open surgical tracheostomy (35 minutes; 3900 kn). CONCLUSIONS: There was no statistically significant difference in postoperative complications (infection, bleeding, subcutaneous emphysema and pneumothorax) between patients with percutaneous dilatational tracheostomy and patients with open surgical tracheostomy. Percutaneous dilatational tracheostomy lasted 15 minutes and open surgical tracheostomy 35 minutes. Percutaneous dilatational tracheostomy was much cheaper than open surgical tracheostomy.