Purpose <p>Neoadjuvant chemotherapy has become one of the initial treatment modalities for advanced ovarian cancer. Previous studies have indicated that preoperative neoadjuvant chemotherapy may reduce patients’ requirements for anesthetic agents. This study aims to investigate the effect of neoadjuvant chemotherapy on post-induction hypotension.</p> Patients and methods <p>This study enrolled a total of 532 patients, with 482 included in the primary analysis. Multivariable logistic regression and propensity score matching were used to analyze the association between Neoadjuvant chemotherapy and post-induction hypotension. Multiple sensitivity analyses were performed, including the use of alternative MAP thresholds, multiple imputation, inverse probability weighting, and E-value methods.</p> Results <p>This study enrolled a total of 532 patients, of whom 482 were included in the primary analysis. After propensity score matching, each group included 161 patients. The incidence of PIH were 29.19% in the non-NC group and 52.80% in the NC group (<i>p</i> &lt; 0.001). Neoadjuvant chemotherapy was identified as an independent risk factor for post-induction hypotension in patients with ovarian cancer [adjusted OR 2.89 (1.90–4.42)], <i>p</i> &lt; 0.001. Sensitivity analyses further supported the main conclusion.</p> Conclusion <p>Patients receiving neoadjuvant chemotherapy were 2.89 times more likely to experience post-induction hypotension compared with those who did not, within the first 20&#xa0;min after anesthesia induction.</p>