<p>Managing the airway in non-intubable, non-ventilable patients is a critical situation requiring immediate intervention. The American Society of Anesthesiologists (ASA) recommends tracheostomy as an emergent technique to prevent death in cases of failed intubation, though it involves significant risks. To determine the factors associated with elective and emergency tracheostomy performed by the otorhinolaryngology department of a tertiary university hospital between 2016 and 2023. A retrospective cross-sectional study was conducted on adult patients who underwent surgical tracheostomy performed exclusively by otorhinolaryngologists. Demographic, clinical and procedural variables were analyzed, including comorbidities, indications, complications, length of hospital stay, and mortality. A total of 201 tracheostomies were analyzed: 103 (51.2%) elective and 98 (48.8%) emergency. The mean patient age was 64 years, with a male predominance (82.1%). Oncologic causes accounted for 70.1% of all procedures, with laryngeal cancer being the most frequent indication (49%). Elective tracheostomies were mostly related to planned oncologic surgery, whereas emergency cases were frequently associated with acute upper airway obstruction. The overall complication rate was high, with cannula obstruction (13.4%), surgical site infection (10.9%), and bleeding (10.4%) being the most common. Mortality was significantly higher in emergency tracheostomies (13.3%) compared to elective ones (2.9%). Head and neck cancers and smoking were the main factors associated with tracheostomy, regardless of urgency. Emergency tracheostomy was associated with increased mortality and a greater need for intensive care. Early planning in patients at risk may improve outcomes.</p>