Objective To explore the distribution and influencing factors of intraoperative acquired pressure injury (IAPI) in elderly patients with hip fractures. Methods A total of 238 elderly patients undergoing hip fracture surgery in our hospital from January 2022 to June 2023 were recruited, and according to IAPA occurrence or not, they were divided into IAPA group (n=41) and control group (n=197). SPSS 22.0 was used for data analysis. Depending on data type, independent sample t test or Chi-square test was applied for intergroup comparison. Logistic regression model was established to analyze the influencing factors for the occurrence of IAPA in the elderly patients with hip fractures. Results Among the 238 patients, 41 cases developed IAPI, with an incidence rate of 17.23%. The common sites were sacrococcygeal region (21 cases, 51.22%), heel (9 cases, 21.95%) and sole (5 cases, 12.20%). There were 19 patients (46.34%) of IAPI stage 1,13 patients (31.71%) of stage 2,5 patients (12.20%) of stage 3 and 4 patients (9.76%) of stage 4. Binary logistic regression analysis showed that age (OR=1.143, 95%CI 1.045-1.251), body mass index (BMI) ≤18.5 kg/m² or >28 kg/m² (OR=1.652, 95%CI 1.038-2.629), diabetes mellitus (OR=2.073, 95%CI 1.186-3.624), time from fracture to surgery (OR=1.201, 95%CI 1.039-1.388) and frequency of turning over ≥3 times per day (OR=0.388, 95%CI 0.209-0.721) were independent influencing factors for IAPI in elderly patients undergoing hip fracture surgery (P<0.05). Conclusion The incidence of IAPI is quite high in elderly patients undergoing hip fracture surgery, and the injuries are common in sacrococcygeal region, heel and sole. Age, BMI, diabetes mellitus, time from fracture to surgery and frequency of turning over per day are the influencing factors for IAPI occurrence.