<p>This study aimed to ascertain the incidence, clinical characteristics, and risk factors of hospital-acquired pressure injuries in neurosurgery inpatients and to provide a reference for preventive care. Adhering to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, we conducted a prospective cohort study involving 1,192 patients admitted to the Department of Neurosurgery at a grade A tertiary hospital in western China from April 2023 to March 2024. During a total of 14,091 patient-days of follow-up, the incidence density of hospital-acquired pressure injuries was 0.003 per patient-day, with a cumulative incidence of 3.6%. Standardized forms were utilized to collect demographic, clinical, laboratory, and pressure injury data. The study revealed that the buttocks (20 cases, 37%) and sacral region (13 cases, 24.1%) were the predominant sites of hospital-acquired pressure injuries, predominantly presenting as stage 1 (21 cases, 38.9%) and stage 2 (27 cases, 50%) pressure injuries. Edema (<i>P</i> = 0.014) and albumin (<i>P</i> = 0.049) were identified as independent risk factors for the development of hospital-acquired pressure injuries. The results of this study highlight the need to monitor patients’ edema status and albumin levels, emphasize the importance of rapid control of acute inflammation, and suggest appropriate albumin supplementation to reduce the risk of hospital-acquired pressure injury.</p>