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It is important to characterize the developing complication profile of the open approach as it becomes reserved for more complex disease during the endoscopic era. Our objective was to characterize complication rates of current open skull base surgery.Retrospective chart review.Tertiary care center.The study group consisted of 103 patients and 117 open skull base surgeries were performed from 2008 to 2012.Intraoperative/postoperative complications.Fisher exact test and Wilcoxon rank sum test evaluated for associations of complications with potential risk factors.Postoperative complications occurred in 53 (45%) cases, of which 36 (31%) were major complications. Malignancy, dural grafting, age, and obesity were not associated with complications. Flap reconstruction was associated with increased complication rates (odds ratio = 2.27; 95% confidence interval: 1.03-5.04).The open approach is increasingly utilized for only the most complex lesions, and selection bias cannot be overstated in comparative series. This study suggests that current open complication rates may be above those cited from prior studies, and patient and physician expectations should be adjusted accordingly.