Perioperative neurocognitive dysfunction is a common and frequent complication after anaesthesia and surgery, which seriously threatens the physical and mental health of patients, affects their quality of life, and imposes a heavy economic burden on the family and society. Gut microflora and their metabolites are closely related to the development of perioperative neurocognitive dysfunction, which affects the cognitive and behavioural abilities of patients through the microbe-gut-brain axis and the establishment of bidirectional communication with the central nervous system. Indole-3-propionic acid, a small molecule metabolite produced by intestinal microflora through the degradation of tryptophan via the indole metabolic pathway, has attracted attention because of its barrier-maintaining, immunomodulatory, anti-inflammatory and antioxidant and neuroprotective effects. This article provides a review of the current state of research on the protective role of indole-3-propionic acid in perioperative cognitive dysfunction and its possible mechanisms, and summarises the factors that may affect indole-3-propionic acid levels in vivo, with the aim of providing potential new intervention strategies and targets for the prevention and treatment of perioperative neurocognitive dysfunction.