Background <p>This study aims to synthesize existing evidence regarding the accuracy of different scales to assess the risk of intraoperative acquired pressure injury (IAPI), thus providing guidance for the accurate clinical screening of IAPI risk and helping to prevent and reduce the occurrence of IAPI.</p> Methods <p>We searched the following electronic databases to identify relevant studies on scales to assess the risk of IAPIs among adults: PubMed, the Cochrane Library, Embase, Web of Science, CNKI, VIP, the WanFang Database, and the Chinese Biomedical Literature Database. Two authors independently screened the literature, evaluated the quality of the included studies, and extracted the data. The QUADAS-2 tool was used to rate the quality of evidence. ANOVA was performed via Stata and R software to implement diagnostic network meta-analysis via the Bayesian method to evaluate the predictive power of the dominance index.</p> Results <p>A total of 24 studies (6721 patients) were included, and the incidence of IAPIs was 12.30% (827/6721). Six IAPI risk assessment tools were used, and their rankings on the basis of the Bayesian dominance index were as follows: the ELPO Scale, 3.12 (95% CI: 0.14, 9); the Norton Scale, 2.63 (95% CI: 0.14, 11); the Waterlow Scale, 2.44 (95% CI: 0.14, 7); the Munro Scale, 2.39 (95% CI: 0.20, 7); the Scott Triggers tool, 1.55 (95% CI: 0.11, 5); and the Braden Scale, 0.36 (95% CI: 0.09, 3).</p> Conclusions <p>We found that the ELPO Scale has good diagnostic test accuracy, and it is recommended that clinical workers prioritize the use of this scale in assessing the risk of pressure injuries among surgical patients, thereby enhancing the effectiveness of risk assessment for pressure injuries among surgical patients.</p> Trial registration <p>This study has been registered on PROSPERO (CRD42023470664).</p>