Objective To investigate the incidence of delayed emergence from general anesthesia after neurosurgical craniotomy. Methods A total of 11,878 patients who underwent neurosurgery in Beijing Tiantan Hospital from Jan 2015 to Jun 2020 were enrolled and their clinical data were retrospectively analyzed. All the patients were conscious before surgery, and then received general anesthesia and mechanical ventilation during craniotomy. After surgery, tracheal extubation was performed in the operating room before admission to the post‑anesthesia care unit. Postoperative consciousness and vital signs were recorded. According to their age (±2 years), sex and date of surgery (±14 d), patients with delayed emergence were matched at a ratio of 1∶1, and were then divided into two groups (n=107): a delayed emergence group and a control group. Single‑factor Logistic regression was performed on variables with statistical differences between the groups, and variables with P<0.05 in the single‑factor regression were included in the multivariate Logistic regression to explore the related risk factors of delayed recovery after brain tumor resection. Results The incidence of delayed emergence was 0.9% (107/11 878). The delayed emergence group presented increases in the percentage of body mass index (BMI)<25 kg/m2, American Society of Anesthesiologists (ASA) grade Ⅲ‒Ⅳand Karnofsky Performance Status Scale (KPS) score<80 before surgery, brain tumor diameter>4 cm, WHO pathological grade Ⅲ‒Ⅳ and operation duration>4 h, as well as decreases in the dosage of sufentanil, compared with the control group (P<0.05). Multivariate Logistic regression showed that BMI<25 kg/m2 [odds ratio (OR)=0.451，95%CI 0.238‒0.854，P=0.015], KPS<80 before surgery (OR=3.449，95%CI 1.282‒9.279，P=0.014), WHO grade Ⅲ‒Ⅳ(OR=3.499，95%CI 1.744‒7.018，P<0.001) and operative duration>4 h (OR=4.623，95%CI 2.425‒8.816，P<0.001) were the risk factors for delayed emergence from general anesthesia after brain tumor resection (P<0.05). Conclusions Delayed emergence after neurosurgery is not rare, and BMI<25 kg/m2, KPS score<80 before surgery, WHO grade Ⅲ‒Ⅳ and operation duration> 4 h are the risk factors of delayed emergence after resection of brain tumor.