Background <p>Although Montgomery T-tube implantation has become an effective method for treating tracheal stenosis, the T-tube needs to be removed as a temporary treatment. At present, there is still a lack of research on the relevant factors affecting T-tube extraction. Therefore, we aimed to explore the clinical characteristics of post-tracheotomy tracheal stenosis (PTTS) disease and the risk factors affecting Montgomery T-tube extraction.</p> Methods <p>Retrospective analysis of patients who underwent Montgomery T-tube implantation in the Respiratory and Critical Care Medicine of Emergency General Hospital and the Department of Respiratory Medicine at Dongzhimen Hospital from June 2014 to September 2024. They were followed up for at least 6 months. T-tube extraction was used as the main outcome measure. A logarithmic rank test was used to analyze the association between clinical characteristics and T-tube extraction. Kaplan-Meier analysis was performed to analyze the rate of T-tube extraction. Multivariate stepwise Cox regression analysis was used to explore the variables that may affect the association of T-tube extraction.</p> Results <p>A total of 49 patients were included, and 18 (36.7%) patients had successful extraction. In the Kaplan-Meier analysis, the rate of extubation was lower in patients with BMI ≥ 24, diabetes mellitus, and a narrow distance of less than or equal to 1&#xa0;cm from the glottis (<i>P</i> &lt; 0.05). In multivariate Cox regression analysis, cerebrovascular disease (HR 0.341, 95% confidence interval [CI] 0.127–0.918) and diabetes mellitus (HR 0.216, 95% confidence interval [CI] 0.049–0.959) may be independent risk factors for T-tube extraction.</p> Conclusions <p>Diabetes mellitus and cerebrovascular diseases are independent risk factors for T-tube extraction, and more attention should be paid to these patients in clinical practice.</p> Clinical trial number <p>This study is a retrospective observational study, and no clinical trial registration number was applied for.</p>