Objective: To investigate the effect of oral carbohydrate administration 2 hours before surgery on the incidence of postoperative delirium in elderly patients undergoing elective laparoscopic colorectal cancer resection. Methods: 60 elderly patients aged 60~79 years, ASA grade I~III, scheduled for elective laparoscopic radical colorectal cancer resection under general anesthesia were selected. They were divided into carbohydrate group (CHO group, n=31) and control group (C group, n=29) according to different anesthesia methods. The C group followed conventional preoperative fasting (8 hours for solids, 6 hours for clear fluids). The CHO group, in addition to conventional fasting, orally ingested 200 mL of a carbohydrate beverage 2 hours before surgery. General patient data were recorded and compared. The incidence of delirium within 5 days postoperatively was assessed twice daily using the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM). Fasting blood glucose (FBG), serum interleukin-6 (IL-6), and C-reactive protein (CRP) levels were measured preoperatively and on postoperative days 1, 3, and 5. Perioperative incidences of thirst, hunger, nausea, and vomiting were also recorded. Results: The overall incidence of postoperative delirium in the CHO group was lower than that in the C group (P<0.05). The levels of FBG, IL-6, and CRP in both groups increased 1 day after surgery compared to preoperative (P<0.001). Compared to the C group, the CHO group had lower FBG, IL-6, and CRP levels on days 1 and 3 (P<0.05). The incidence of perioperative thirst was lower in the CHO group than in the C group (12.90% vs. 44.83%, P<0.05), while no significant differences were found in the incidence of nausea or vomiting between the two groups. Conclusion: For elderly patients undergoing elective laparoscopic colorectal cancer resection, preoperative oral carbohydrate intake 2 hours before surgery can effectively reduce the incidence of postoperative delirium. The underlying mechanism may be associated with attenuating the postoperative stress response, reducing inflammatory cytokine levels, and improving patient perioperative comfort.