Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 Articles in Press 2026 07 24 Psychological and Neurocognitive Outcomes After Major Surgery in Older Adults: Redefining Surgical Success Beyond Traditional Outcomes 737966 10.22088/caspjs.2026.2092568.1069 EN Gooya Tayyebi Psychosomatic Research Center, Department of Psychiatry, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 0000-0001-5516-0798 Dorsa Kiani Psychosomatic Research Center, Department of Psychiatry, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 0000-0003-1680-7987 Maedeh Bagheri Psychosomatic Research Center, Department of Psychiatry, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 0000-0002-0574-678X Seyed Kazem Malakouti Geriatric Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran. 0000-0003-4978-6449 Seyed Hamzeh Hosseini Psychosomatic Research Center, Department of Psychiatry, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 0009-0001-0826-7637 Journal Article 2026 06 26 Major surgery in older adults is increasingly common as life expectancy rises and advances in surgical, anesthetic, and intensive care practices expand treatment options for this population. However, conventional surgical outcomes do not fully reflect the complexity of recovery in older patients. Psychological and neurocognitive complications represent frequent, clinically meaningful, and often under-recognized determinants of postoperative recovery. Older adults undergoing coronary artery bypass grafting, valve surgery, aortic and major vascular procedures, thoracic surgery, abdominal oncologic surgery, and hip fracture repair are particularly vulnerable to postoperative delirium, perioperative neurocognitive disorders, depression, anxiety, sleep disturbances, post-traumatic stress symptoms, and post-intensive care syndrome. The development of these complications is multifactorial, involving interacting biological factors (neuroinflammation, cerebral hypoperfusion, and systemic stress responses), patient-related clinical factors (frailty, pre-existing cognitive impairment, pain, and polypharmacy), environmental and healthcare-related factors (intensive care exposure, sensory deprivation, and sleep disruption), and psychosocial factors (social isolation, emotional distress, and psychological stress associated with life-threatening illness). This narrative review integrates evidence from diverse surgical populations to provide a comprehensive framework linking preoperative vulnerability, perioperative insults, and postoperative psychological and neurocognitive outcomes. Beyond summarizing existing knowledge, this review proposes a patient-centered model of surgical success that extends beyond survival and technical outcomes to include preservation of cognition, emotional well-being, sleep recovery, functional independence, and return to meaningful daily activities. By integrating geriatric, surgical, anesthetic, and psychological perspectives, this review highlights the need for a multidimensional approach to evaluating outcomes after major surgery in older adults.