Perioperative neurocognitive disorders (PND) are common complications associated with anesthesia and surgery, significantly increasing perioperative morbidity and mortality. Microglial autophagy, a crucial lysosomal degradation pathway, plays an essential role in PND. This article focuses on the protective effects of microglial autophagy on PND, highlighting its regulation of phenotypic polarization and neuroinflammation. It reviews both clinical and fundamental studies related to microglial autophagy and PND, summarizing the protective mechanisms identified in relevant investigations. The aim is to provide novel insights and references for the prevention and treatment of PND.