Purpose <p>This meta-analysis aimed to evaluate the incidence and risk factors of intraoperative acquired pressure injuries (IAPIs) in open heart surgical patients, focusing exclusively on prospective studies to address gaps in the existing literature.</p> Methods <p>A systematic search was conducted across PubMed, Embase, and Web of Science up to January 2025. Data on incidence and risk factors were extracted, and statistical analyses were performed using random-effects models. Heterogeneity was assessed using <i>I</i>^<i>2</i> statistics; publication bias was assessed by funnel plot and Egger’s test.</p> Results <p>Ten prospective studies involving 1311 patients were included. The pooled incidence of IAPIs was 25% (95% CI 16%–35%), with high heterogeneity (<i>I</i>^<i>2</i> = 94%). Sensitivity analysis confirmed stable results. Significant risk factors included prolonged surgical duration (SMD: 1.76, 95% CI 0.10–3.42, <i>I</i>^<i>2</i> = 98%), advanced age (SMD: 0.30, 95% CI 0.14–0.46, <i>I</i>^<i>2</i> = 0%), female sex (RR: 1.36, 95% CI 1.03–1.80, <i>I</i>^<i>2</i> = 53%), and perioperative corticosteroid use (RR: 3.63, 95% CI 1.64–8.06, <i>I</i>^<i>2</i> = 0%).</p> Conclusion <p>This study assessed the incidence of IAPIs in open heart surgical patients and identifies key risk factors, including prolonged surgical duration, advanced age, female sex, and perioperative corticosteroid use. However, the results should be interpreted with caution due to the high heterogeneity observed across studies. Future research should focus on larger, multicenter prospective studies to provide more robust evidence.</p>