Objective: To investigate the clinical factors affecting postoperative cognitive dysfunction (POCD) in elderly patients with esophageal cancer undergoing general anesthesia and to propose targeted anesthesia management strategies. Methods: This study was a retrospective analysis. A total of 71 elderly patients who underwent esophageal cancer resection under general anesthesia between January 2023 and December 2024 were included.According to whether postoperative cognitive impairment (POCD) occurred on the 7th day after surgery, they were divided into POCD group (20 cases) and non POCD group (51 cases). Collect and compare basic clinical information, intraoperative operation related parameters, and various anesthesia management indicators between two groups of subjects. Analyze the risk factors that affect the occurrence of POCD and evaluate the goodness of fit of the model.Results: The incidences of age ≥75 years, comorbid diabetes mellitus, intraoperative hypotension duration ≥30 min, BIS <40, postoperative VAS score ≥4 points, and postoperative nausea and vomiting in the POCD group were higher than those in the non-POCD group (P<0.05). Age ≥75 years, comorbid diabetes mellitus, hypotension duration ≥30 min, BIS <40, postoperative VAS score ≥4 points, and postoperative nausea and vomiting were all independent risk factors for POCD (P<0.05). The Hosmer Lemeshow test results showed that, χ2=6.342，P=0.608， Good goodness of fit of the model. The AUC of the joint predictive factors was significantly better than that of each individual indicator (P<0.05). Conclusion: Advanced age, low education level, comorbid diabetes mellitus, prolonged intraoperative hypotension, excessive anesthesia depth, postoperative pain, and nausea and vomiting are independent risk factors for POCD in elderly patients with esophageal cancer undergoing general anesthesia. Refined anesthesia management can be implemented targeting the above factors.