Although the neurofilament light chain (NfL) is used as a biomarker for neurodegenerative decline, its use in surgery- and anaesthesia-induced acute cognitive dysfunction remains controversial. We aimed to synthesise the evidence to explore the potential of NfL as an established biomarker for perioperative neurocognitive disorders (PND). We systematically searched the PubMed, EMBASE, MEDLINE, Cochrane Library electronic databases, and Cochrane Central Registry of Clinical Trials. Our results show that CSF NfL levels positively correlated with blood NfL levels (r = 0.63; 95% confidence interval [CI], 0.42-0.77). The pooled standardised mean difference (SMD) showed a significantly higher preoperative CSF NfL levels (SMD = 0.27; 95% CI, 0.07-0.47) and both pre- and postoperative blood NfL levels (SMD = 0.53, 95% CI, 0.40-0.66 and SMD = 0.58, 95% CI, 0.43-0.73) in the postoperative delirium (POD) group. Postoperative blood NfL levels were significantly elevated in both POD group (SMD = 0.49; 95% CI, 0.34-0.64) and no-POD group (SMD = 0.67; 95% CI, 0.53-0.81). Our meta-analysis indicates that NfL may serve as a potential biomarker for POD, and elevated preoperative blood NfL levels could be a risk factor for POD. Further studies are needed to confirm the association of CSF/blood NfL levels with other PND types.