BACKGROUND Tracheostomy is a lifesaving procedure that has stood the test of time. Reports of surgically securing the airway dates back to ancient times. However, Chevalier Jackson is credited with the first clear open surgical description in 1909. Only during the last three decades has this operation assumed its rightful place as a simple and safe procedure. During recent years, the complications and deaths due to tracheostomy have markedly decreased. But, complications do occur and there is not much published data, especially in the recent years on complications of tracheostomy. Hence, this study was conducted at Government Medical College, Thiruvananthapuram, to assess the incidence of immediate, intermediate and late complications of tracheostomy and to study the steps taken to manage these complications. MATERIALS AND METHODS The study was conducted on 205 patients who underwent tracheostomy, both emergency and elective between June 2013 and December 2014 at Medical College Hospital, Thiruvananthapuram. RESULTS The incidence of complications was found to be 28.3%. The most common immediate complications were bleeding and cardiopulmonary arrest. The most common intermediate complication was infection and difficult decannulation was the most common late complication. CONCLUSION Knowledge of probable complications and their causative factors is necessary to tackle and prevent them. Majority of the complications can be avoided by using non-metallic tracheostomy tubes, patients seeking early treatment, the expertise of the surgeon, adequate tracheostomy care and regular follow up.