Objective To analyze the relationship between microenvironment of the compressed area and intraoperatively acquired pressure injury (IAPI), so as to provide reference for clinical practice of preventive measures. Methods A sample of 99 patients underwent elective surgery were studied to collect their demographic data, surgery-related data, skin temperature and humidity of the compressed area. Results The incidence of IAPI was 10.10% in prone position surgery. IAPI occurred more frequently within 24 hours after the surgery, and at the zygoma and the anterior superior iliac spine. Elevation of skin temperature and core temperature were risk factors of IAPI in prone position surgery (OR=8.215,7.186, P<0.05 for both). Conclusion Microenvironment of the compressed site may affect the occurrence of IAPI in prone position surgery. Targeted interventions should be taken to prevent IAPI.