Low Surgical Apgar Score (SAS) predicts delayed neurocognitive recovery (DNCR) after surgery in elderly patients.

• DNCR incidence was 23.86%, with 15.7% at 7 days and 19.6% at 30 days postoperative.
• SAS < 8 identifies a high-risk population; logistic regression shows it has an odds ratio of 6.326 for DNCR.
• Other risk factors include sleep quality, frailty, and anxiety.

Early identification using SAS can guide interventions to improve patient outcomes.