Objective To investigate the risk factors and prognostic impact of postoperative delirium (POD) in elderly patients after hepatectomy. Methods A retrospective observational study was conductd on 314 elderly patients who underwent hepatectomy under general anesthesia in Xuzhou Central Hospital from January 2018 to January 2022. According to whether the patients had POD or not, the patients were divided into POD group (n=66) and non-POD group (n=248). SPSS software Version 26 and R software Version 4.1.2 were used for data analysis and graphing. Depending on data types, student′s t test, Rank sum test, Chi-square test, Fisher′s exact test or Wilcoxon rank sum test was employed for intergroup comparison. Univariate analysis and multivariate logistic regression were applied to analyze the independent risk factors of POD in elderly patients after hepatectomy. Results Among the 314 enrolled elderly patients, 66 (21.0%) developed POD. Advanced age (OR=1.167,95%CI 1.058-1.287; P<0.001), body mass index<18.5 kg/m²(OR=2.115,95%CI 1.124-3.980; P=0.018), lower preoperative mini-mental state examination score (OR=1.096,95%CI 1.047-1.148; P=0.021), higher preoperative Charlson comorbidity index (OR=1.458,95%CI 1.132-1.878; P=0.007), longer operation time (OR=1.043,95%CI 1.025-1.061; P=0.010), intensive care unit admission after operation (OR=2.481,95%CI 1.554-3.961; P<0.001), higher postoperative 24 h visual analogue scale score (OR=1.038,95%CI 1.017-1.059; P=0.014) were independent risk factors for POD in elderly patients after hepatectomy. After calculation, multivariate logistic regression model has good discriminative ability for postoperative POD (area under curve=0.865,95%CI 0.795-0.936) and has a high degree of fit (Hosmer-Lemeshow goodness of fit test, χ²=5.199, P=0.804). Conclusion Surgeons and anesthesiologists can identify elderly patients with high risk of POD through preoperative assessment as early as possible. Improvement of preoperative status and optimization of perioperative management can reduce the incidence of POD in elderly patients after hepatectomy.