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Objectives To identify care-related factors associated with hospital-acquired pressure ulcers ( HAPUs). Design Prospective cohort study. Setting Nine hospitals in Baltimore Hip Studies network. Participants Six hundred fifty-eight individuals aged 65 and older who underwent surgery for hip fracture. Measurements Skin examinations at baseline and on alternating days until hospital discharge. Participants were deemed to have a HAPU if they developed one or more new Stage 2 or higher pressure ulcers ( PUs) during the hospital stay. Results Longer emergency department stays were associated with lower HAPU incidence (>4-6 hours: adjusted incidence rate ratio ( aIRR) = 0.68, 95% confidence interval (CI) = 0.48-0.96; >6 hours: aIRR = 0.68, 95% CI = 0.46-0.99, both vs ≤ 4 hours). Participants with 24 hours or longer between admission and surgery had a higher postsurgery HAPU rate than those with less than 24 hours ( aIRR = 1.62, 95% CI = 1.24-2.11). Surgery with general anesthesia had a lower postsurgery HAPU rate than surgery with other types of anesthesia ( aIRR = 0.66, 95% CI = 0.49-0.88). There was no significant association between HAPU incidence and timing of transport to the hospital, type of transport to the hospital, or surgery duration. Conclusion Most of the factors hypothesized to be associated with higher PU incidence were associated with lower incidence or were not significantly associated, suggesting that HAPU development may not be as sensitive to care-related factors as commonly believed. Rigorous studies of innovative preventive interventions are needed to inform policy and practice. [ABSTRACT FROM AUTHOR]