Purpose: To identify and measure risk factors relating to complications in patients undergoing Percutaneous Tracheostomy (PT) and Surgical Tracheostomy (ST) and to investigate the effect of bronchoscopy guidance on the rate of complications in patients undergoing PT in an urban tertiary hospital in New Zealand. Methodology: A retrospective database search identified 280 patients admitted to the Department of Critical Care Medicine at Auckland City Hospital (26-bed tertiary intensive care unit) who underwent a tracheostomy during their admission from 2017 to 2021. Patients’ baseline characteristics, the use of the bronchoscope, the type of tracheostomy and immediate and short-term complications related to the tracheostomy were identified. Results: 201 patients underwent PT and 77 underwent ST. 27 complications occurred in 24 patients, giving a per-patient complication rate of 9%. The per-patient complication rate for PT was 20/201 (10%) and for ST was 4/77 (5%) (P = 0.24). The most common complication was tracheostomy-associated bleeding. The use of a bronchoscope may have prevented 3 complications. The highest complication rates were observed in those with a BMI greater than 30 (17.1%), those in the 6th decade of life (18.8%), in Indian (27.2%) and Māori ethnicities (21.3%) and those who received a tracheostomy more than 10 days after intubation (23.1%) Conclusion: The complication rates were not statistically different for PT and ST. For the PT group, the use of a bronchoscope was not associated with a statistical difference in the complication rate.