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Background: Tracheostomy is common among intensive care unit (ICU) patients. Reconsideration of tracheostomy indications in patients can be effective in modifying and reducing irrevocable patient complaints. The present study aimed to analyze the prevalence of tracheostomy indications and to estimate the prevalence of tracheostomy in Iran. Materials and Methods: In this systematic review and meta-analysis, scientific databases were searched from January 1990 to April 2018. The inclusion criteria were as follows: 1) use of the term "tracheotomy" in the title; and 2) studies conducted in Iran. On the other hand, the exclusion criteria were: 1) studies that did not specify the type of mechanical ventilation; 2) studies that did not quantitatively report the indications; 3) studies without access to the full-text; and 4) case studies, letters to the editor, and/or prefaces. Data were extracted from published reports. Our preliminary results included estimations of tracheostomy indications in Iran. Results: In the preliminary search, a total of 325 articles were found, 24 of which were considered eligible. Among 2860 patients who had undergone tracheostomy, 21 indications were identified. Decreased mental status, respiratory disease, and tumors were the most frequent indications. The prevalence of tracheostomy was 40.59% in Iran, with the highest and lowest rates reported in Birjand and Ardabil, respectively (136.50 and 6.63 in 100,000 people, respectively) based on the random effects model. Conclusion: The most prevalent indications in Iran are different from those reported in other countries. This difference may be due to the lack of trained medical personnel and available technologies. [ABSTRACT FROM AUTHOR]