Introduction: Decannulation, the removal of the tracheostomy tube, is an essential procedure that a treating team must consider for all tracheostomized patients. There is a lack of evidence available regarding the factors that are associated with the outcomes of the decannulation process. The study aims to detect the outcome of decannulation, describe factors associated with failed decannulation and to describe the decannulation practice in adult patients at a tertiary hospital in Riyadh, Saudi Arabia. Methodology: We performed a retrospective descriptive study for 210 tracheostomized patients aged 18 and above from January 2016 to December 2017. Demographic data, tracheostomy data, and decannulation process data were collected and entered in Microsoft Excel and exported to SPSS for the analysis. Results: Among 210 patients, the majority of tracheostomies were done at the bedside (55.2%). A total of 186 (88.6%) patients were successfully decannulated within 6 months. Obesity, comorbidity, and Glasgow Coma Scale (GCS) during admission were not associated with failure. Faster decannulation (73.5%) was found in those patients ventilated <7 days. Among 41 patients who underwent failed trials of decannulation, the most common reason of failure was desaturation in 19 patients (46.3%). Six patients of them had a combination of desaturation with other factors such as secretions, low GCS, and vocal cord paralysis. Conclusion: Successful decannulation within 7 days is related to the presence of full tracheostomy team. However, having a protocol approach will be more helpful. The study showed favorable outcome for young patients and those who had an early tracheostomy in the intensive care unit.