Objective To explore the effect of individualized intraoperative blood pressure management strategy on postoperative neurocognitive function of elderly patients undergoing major abdominal surgery. Methods Two-hundred and ten elderly patients, admitted in the Second Affiliated Hospital of Anhui Medical University from September 2018 to September 2020 and undergone elective major abdominal surgery, were randomly divided into individualized group and control group with random number table method. In individualized group, the SBP was maintained within ±10% of the basic value; while in control group,the SBP was maintained ≥90 mmHg or decreased not exceed 40% of the basic value. The patient's SBP, diastolic blood pressure(DBP), mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) of EEG were recorded before induction of anesthesia (T₀), start of surgery (T₁), 30 min (T₂), 60 min (T₃), 90 min (T₄), 120 min (T₅) and 150 min (T₆) after surgery and at the end of the operation (T₇). The basic neurocognitive function of the patients was evaluated with the Simple Intelligent Mental State Scale (MMSE) 1 day before the operation, and the scores of the Chinese revised delirium diagnostic scale (CAM-CR) and MMSE scores were recorded on the 1st, 3rd and 7th day after the operation. The cognitive function telephone questionnaire (TICS-m)was scored 1 month after surgery, and the length of hospital stay and serious complications were recorded. Results Compared with that in control group, the proportion of patients using norepinephrine increased significantly [72.4% (76/105) vs. 19.0%(20/105), P<0.001], and the placement time of drainage tube and postoperative hospital stay shortened significantly [(10.9±3.5) d vs. (12.8±5.0) d, P=0.039; (21.0±5.6) d vs. (23.6±6.2) d, P=0.038] in individualized group. No significant differences existed between the two groups in operation time, total infusion volume, bleeding volume, urine volume and first postoperative ventilation time (P>0.05). Compared with T₀, SBP, MAP and BIS decreased significantly at T₁-T₇, HR decreased significantly at T₁-T₆ (P<0.05)in the both groups, DBP decreased significantly at T₁-T₃ and T₅-T₇ in individualized group (P<0.05), and at T₁-T₇ in control group(P<0.05). Compared with control group, SBP and MAP increased significantly at T₁-T₇ in individualized group (P<0.05), and DBP increased significantly at T₄ (P<0.05). Compared with control group, the MMSE score increased significantly on the 1st and 3rd day after operation [(24.0±2.8) points vs. (22.8±2.7) points, P=0.032; (24.7±2.7) points vs. (23.6±2.4) points, P=0.037], and the CAM-CR score decreased significantly [(15.4±3.6) points vs. (17.2±4.2) points, P=0.040; (12.8±2.7) points vs. (14.2±3.1)points, P=0.028] in individualized group. No significant differences existed between the two groups in the MMSE and CAM-CR scores on the 7th day, the VAS scores on the 1st and 3rd day, and the TICS-m scores at 1 month after operation, as well as the incidence of serious complications (P>0.05). Conclusion Individualized management of elderly patients undergoing major abdominal surgery to maintain SBP fluctuations within ±10% of the basic value during operation can help improvement of early postoperative neurocognitive function and shortening the length of hospital stay, but had no significant effect on neurocognitive function at one month after operation.