Objective To investigate the risk factors of delayed tracheal extubation after fast-track anesthesia (FTA) for coronary artery bypass grafting (CABG). Methods A total of 404 patients with CABG who were admitted from November 2021 to November 2022 were retrospectively selected. According to the time of postoperative tracheal extubation, they were divided into two groups: a normal extubation group (≤ 6 h, n=216) and a delayed extubation group (> 6 h, n=188). Both groups were compared for baseline data, surgical data and prognosis. Multivariate logistic regression was performed to analyze the independent risk factors of delayed tracheal extubation. A risk prediction model was established, and the optimal cut‑off values were obtained based on receiver operating characteristic curve (ROC). The area under curve (AUC) was calculated to evaluate the prediction efficiency of the model. Results The delayed extubation group had older ages, and more female patients, with a higher percentage of patients with New York Heart Association (NYHA) cardiac function grade ≥Ⅲ, and higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Synergy between PCI with TAXUS and Cardiac Surgery (SYNTAX) scores than the normal extubation group (all P<0.05). Compared with the normal extubation group, the delayed extubation group also showed increases in operation time, cardiopulmonary bypass (CPB) time and aortic occlusion time, intraoperative lactic acid (Lac), as well as the number of cases of intraoperative blood product infusion, shivering and perioperative intra-aortic balloon pump (IABP) (all P<0.05); and increases in the secondary intubation rate, the length of intensive care unit (ICU) stay, the total length of hospitalization stay, and the incidences of pneumothorax, atelectasis and pleural effusion (all P<0.05). There was no statistical difference in other indexes between the two groups (all P>0.05). According to multivariate logistic regression, female [odds ratio (OR) 2.391 (95% confidence interval (CI) 1.430, 3.999), P=0.001], high EuroSCORE score [OR 1.312, (95%CI 1.172, 1.469), P<0.001], high coronary SYNTAX score [OR 1.056 (95%CI 1.018, 1.095), P=0.004], long operation time [OR 1.004 (95%CI 1.001, 1.008), P=0.014], long aortic occlusion time [OR 1.011 (95%CI 1.001, 1.022), P=0.038], perioperative use of intra‑aortic balloon pump (IABP) [OR 9.978 (95%CI 3.832, 25.980), P<0.001], and shivering [OR 2.076 (95%CI 3.832, 25.980), P=0.012] were the independent risk factors for delayed tracheal extubation after CABG under FTA. The best cut‑off values of EuroSCORE score, SYNTAX score, operation time and aortic occlusion time were 5.5, 29.5, 297.5 min and 97.5 min, respectively. The AUC area of the combined predictors was 0.839, with a sensitivity of 0.713, and a specificity of 0.819. Conclusions Female, high EuroSCORE score, high SYNTAX score, long operation time, long aortic occlusion time, perioperative IABP use and shivering are the independent risk factors for delayed tracheal extubation after CABG under FTA.