Objective To establish and validate a tracheal extubation score (TES), so as to determine a more appropriate and accurate extubation time. Methods According to the relevant guidelines and expert consensus on tracheal extubation, three key factors in tracheal extubation were selected: consciousness, muscle strength and respiration. Then, anesthesiology experts were required to evaluate the importance of these factors for establishing the TES method. In the current study, 183 patients who underwent endotracheal intubation from January 2020 to May 2020 were enrolled. The endotracheal tube was removed when the patient's TES was≥2. According to the patient's condition at the time of extubation, the patients were divided into three groups (n=61): a deep anesthesia extubation group (group A, tidal volume≥6 ml/kg, and respiratory rate≥10 times/min, with no response to calling), an awake extubation group (group B, tidal volume≥6 ml/kg, respiratory rate≥10 times/min, muscle strength≥grade 3, being fully awaking and able to follow instructions), and an experimental group (group C, other patients with TES ≥2). The three groups were compared for their general conditions and respiratory adverse events after extubation [① pulse oxygen saturation (SpO2)<90%; ② biting the catheter or dental pad when the endotracheal tube was removed; ③ partial upper airway obstruction requiring mandibular lift or oropharyngeal airway insertion; ④ complete laryngeal spasm; ⑤bronchospasm; ⑥ severe cough lasting more than 10 s], patients' comfort during extubation and the incidence of agitation (Riker sedation agitation score≥5). The correlation analysis was conducted between patient grouping and gender, age, anesthesia time and intraoperative sufentanil dosage. Results There was no significant difference in American Society of Anesthesiologists (ASA) classification and body mass index (BMI) among the three groups (P>0.05). Compared with group A, group B and group C had reduced intraoperative sufentanil consumption, shortened anesthesia time, and an increased proportion of female patients (P<0.05), and patients in group C were older (P<0.05). Compared with group B, group C presented longer anesthesia time and were older (P<0.05). The total incidence of respiratory adverse events after extubation in group C was lower than that in group A (P<0.05). There was no statistical difference in patient's comfort and the incidence of agitation among the three groups (P>0.05). The incidence of adverse events ③ in group A was higher than that in groups B and C (P<0.05). There was no significant difference in the incidence of adverse events (①, ②, ④, ⑤, and ⑥) among the three groups (P>0.05). Patient grouping was positively correlated with gender and age, and negatively correlated with anesthesia time and intraoperative sufentanil dosage. Conclusions TES can be safely applied in clinical practice, and refine the timing of tracheal extubation, which provide reference for proper determination of the timing of tracheal extubation.