Background Despite high expenditure, there is little national data on rates of complications following pressure ulcer repair. Complications, mortality and their predictors following surgical repair of pressure ulcers were evaluated. Methods Patients undergoing pressure ulcer repair were identified in the NSQIP database from 2005 to 2015. Regression models were used to identify risk factors for complications. Results 1248 cases were identified with a complication rate of 35.0%. Obesity was associated with increased risk of complications, whereas flap closure was associated with fewer complications. Thirty-day mortality was 3.3%. Elderly age and diabetes were associated with increased mortality. Conclusions Elderly age, diabetes and dependency are associated with increased mortality following pressure ulcer surgery. Flap repair is associated with decreased complications. Pressure ulcer reconstruction requires careful patient selection and surgical technique to mitigate risks and mortality.