From neuroinflammation to neuroprotection: a bibliometric analysis of anesthesia-associated postoperative cognitive dysfunction to guide clinical research (2000–2024)

Introduction: Postoperative cognitive dysfunction is a common complication following anesthesia and surgery, particularly in elderly patients, yet its pathophysiology and optimal prevention strategies remain incompletely understood. This study employs bibliometric methods to analyze research trends in anesthesia-associated POCD from 2000 to 2024. Methods: A systematic review of 923 publications from the Web of Science Core Collection, cross-validated with the PubMed database, was conducted. Bibliometric analyses were performed using the R package "bibliometrix," VOSviewer, and CiteSpace to evaluate publication trends, key contributors, collaborative networks, co-citation patterns, and keyword evolution. Results: Research output has grown steadily since 2000, with notable acceleration after 2018. The United States leads in productivity and influence, followed by China and Germany. Duke University is the most prolific institution. The British Journal of Anaesthesia and Anesthesiology are the core journals in this field. Keyword analysis reveals an evolution from early focus on surgical types and cognitive assessment toward neuroinflammation as the central pathological mechanism, with increasing attention to the delirium-POCD continuum, anesthetic optimization, and multimodal prevention. Emerging frontiers include the intersection of POCD with Alzheimer's disease pathology, the role of the gut-brain axis, and the translation of mechanistic insights into targeted neuroprotective strategies. Conclusion: This bibliometric analysis delineates the evolution of POCD research from descriptive epidemiology to mechanistic and translational inquiry. Neuroinflammation has emerged as the unifying pathological hub. Key challenges include heterogeneity in diagnostic criteria, difficulty isolating anesthesia effects from surgical trauma, and the gap between preclinical findings and clinical efficacy. Future research priorities should focus on harmonizing diagnostic standards, validating biomarkers, and conducting large-scale multi-center trials to translate mechanistic discoveries into perioperative brain health strategies.