Abstract
Preoperative anxiety, a common perioperative psychological state characterized by restlessness and somatic symptoms, has been reported to affect a broad range of adult surgical patients, with prevalence estimates ranging from approximately 11% to 80% across observational studies, and affects a similar proportion of pediatric patients, with one cross‑sectional study reporting an incidence of around 67.6% in Chinese children undergoing elective surgery. Mounting evidence suggests that preoperative anxiety may be a potential contributing factor to postoperative delirium (POD), an acute cognitive disturbance associated with poor prognosis, increased mortality, and elevated healthcare costs. This mini-review synthesizes the role of preoperative anxiety in predicting POD, highlighting its significance in identifying high-risk populations. This mini-review aims to synthesize current evidence on the impact of preoperative anxiety on POD, clarify underlying pathophysiological mechanisms, and summarize recent pharmacological and non-pharmacological preventive strategies. Mechanistically, preoperative anxiety contributes to POD via systemic and neuroinflammatory responses, blood-brain barrier disruption, postoperative pain amplification, and oxidative stress. Pharmacological interventions (eg, dexmedetomidine, ketamine in pediatric patients) and non-pharmacological strategies (eg, music therapy, virtual reality-based cognitive-behavioral interventions) effectively alleviate preoperative anxiety and reduce POD incidence. Despite progress, the mechanisms linking preoperative anxiety to POD remain incompletely understood, particularly the roles of neuroinflammatory pathways, blood-brain barrier disruption, and the comparative effectiveness of pharmacological versus non-pharmacological interventions. Targeted research in these areas is needed to optimize preventive strategies and improve surgical outcomes.