Objectives/Hypothesis: Percutaneous tracheotomy is progressively replacing open tracheotomy as a consequence of promising results of comparative studies. However, this comparison has four considerable weaknesses: 1) selected indications (high-risk patients excluded for percutaneous tracheotomy); 2) varying spectra of complications included in different studies, 3) varying operative settings (experienced surgeons exclusively, surgeons in training, or both); and 4) missing differentiation between different surgical techniques. Our study was performed to collect complete datasets of unselected patients who all underwent a tracheotomy in a uniform technique in an academic teaching hospital setting. Methods: Retrospective evaluation of all complications following 303 consecutive surgical tracheotomies (midline-open technique) performed by different surgeons and surgeons in training at one academic institution. Complications were classified and compared to results in the literature. Results: Rates of 21.5% minor and 1.0% major complications and 0% tracheotomy-related mortality were registered. The most prevalent complications were local wound infections (10.9%), intra- and postoperative hemorrhages (4.2%), and cartilage damage (1.7%). No significant difference was found for high-risk patients and emergency tracheotomies. Conclusions: Our study demonstrates that open tracheotomy is a safe procedure, particularly if performed in high-risk patients even by inexperienced surgeons. Therefore, we emphasize the advantages of the midline-open tracheotomy in an academic teaching hospital setting.