Perioperative management is essential for ensuring surgical safety and improving patient outcomes. With increasing surgical complexity and patient heterogeneity, traditional experience-based decision-making is no longer sufficient to meet the demands of precision medicine. Recent advances in artificial intelligence (AI), big data analytics, and large language models (LLMs) provide new opportunities to transform perioperative clinical decision support. AI-driven models enable accurate risk stratification and prediction of perioperative complications, while big data technologies facilitate multimodal data integration, real-time monitoring, and personalized intervention strategies. Meanwhile, LLMs enhance clinical communication, support medical documentation, and assist knowledge-based clinical decision-making through advanced natural language processing capabilities. However, despite rapid technological development, a comprehensive framework integrating AI, big data, and LLMs for perioperative intelligent decision-making remains insufficiently explored. This article reviews emerging applications of AI in preoperative risk assessment, intelligent anesthesia management, and postoperative complication prediction, and summarizes the role of big data in integrated clinical platforms and personalized treatment strategies. It also highlights the potential of  LLMs in patient education, clinical decision support systems, and automated knowledge synthesis. Overall, integrating AI, big data, and LLMs may establish an interpretable closed-loop perioperative decision-support ecosystem that improves surgical safety, clinical efficiency, and personalized healthcare delivery.