An increasing number of people undergo anesthesia and surgery. Perioperative neurocognitive and depressive disorders are common central nervous system complications with similar pathogeneses. These conditions pose a deleterious threat to human health and a significant societal burden. In recent years, numerous studies have focused on the role of the gut microbiota and its metabolites in the central nervous system via the gut-brain axis. Its involvement in perioperative neurocognitive and depressive disorders has attracted considerable attention. This review aimed to elucidate the role of the gut microbiota and its metabolites in the pathogenesis of perioperative neurocognitive and depressive disorders, as well as the value of targeted interventions and treatments. Display omitted •Microbiota-gut-brain axis plays a crucial role in perioperative neurocognitive disorders.•Microbiota-gut-brain axis plays a crucial role in perioperative depressive disorders.•Gut microbiota-based interventions may offer promising therapeutic avenues for these disorders.