Study design <p>A retrospective cohort study using a nationwide Japanese inpatient database.</p> Objectives <p>To investigate the association between the timing of rehabilitation interventions and pressure ulcers requiring treatment in acute hospitalized patients with cervical spinal cord injuries between 2010 and 2022 in a real-world clinical setting.</p> Setting <p>We used the Diagnosis Procedure Combination database, a nationwide Japanese inpatient database.</p> Methods <p>We included patients with cervical spinal cord injury who underwent spinal surgery within 3 days of admission between July 2010 and March 2022. We defined rehabilitation within 2 days of surgery as early rehabilitation and ≥3 days of surgery as non-early rehabilitation. The primary outcome was pressure ulcers requiring treatment ≥4 days after admission, and the secondary outcomes were length of hospital stay, hospitalization costs, and in-hospital mortality. Propensity score inverse probability of treatment weighting was conducted to compare the outcomes between the early and non-early rehabilitation groups.</p> Results <p>We identified 5162 eligible patients, 3434 (66.1%) of whom underwent early rehabilitation. After weighting, the pressure ulcers requiring treatment showed no significant difference between the early and non-early rehabilitation groups (odds ratio, 1.42; 95% confidence interval [CI], 0.78–2.59; P = 0.249). The early rehabilitation group showed shorter length of hospital stay (difference, −7.4; 95% CI, −13.1–−1.3%; P = 0.018) than did the non-early rehabilitation group.</p> Conclusion <p>This study found no significant difference in the pressure ulcers requiring treatment between the early and non-early rehabilitation groups.</p>