BACKGROUND: Tracheostomy is considered to be effective in the respiratory support of mechanically ventilated patients. We studied a single-center experience of surgical tracheostomy in mechanically ventilated patients to describe the demographics, risk factors, and outcomes of early (< 14 d after ventilation) versus late surgical tracheostomy (> 15 d after ventilation). METHODS: In this retrospective study, we collected demographic data, medical history, timing of surgical tracheostomy in relation to ventilation day, blood test results, preoperative surgical assessment (subjective impression of neck length, difficulty in neck extension, presence of a goiter), intraoperative complications (bleeding > 100 mL, difficulties in cannula insertion), and postoperative morbidities (bleeding, wound infection, fever, inadvertent de-cannulation, and 30-d postoperative mortality rate) of subjects who underwent surgical tracheostomy in a secondary medical center during 2010–2015. Morbidity and mortality rates were compared between the early versus late surgical tracheostomy groups. RESULTS: Three hundred eleven subjects underwent surgical tracheostomy and met the eligibility criteria. Most of subjects were elderly, with a mean age of 82 y (range 62.5–88 y). There were 22 (7%) subjects in the early surgical tracheostomy group and 289 (93%) subjects in the late surgical tracheostomy group. Late surgical tracheostomy subjects were significantly older compared to early surgical tracheostomy subjects (me-dian age 82 y vs 74 y, P = .001). With regard to intraoperative complications, no appreciable differences were observed between the groups. Timing of surgical tracheostomy was not associated with greater morbidity rates, nor was timing associated with higher postoperative complication rates. Those who survived 30 d were younger than those who died (median 81 vs 83 years, hazard ratio = 1.03). CONCLUSION: In elderly subjects, late surgical tracheostomy was not associated with increased 30-d morbidity or mortality rates. Comorbid conditions and subject age had a greater association with 30-d mortality rate than surgical tracheostomy timing. Key words: tracheostomy; elderly; mortality; morbidity; complication. [Respir Care 2018;63(8):1009–1015.