Acquired, in-hospital risk factors that contribute to venous thromboembolism (VTE) risk after thermal injury remain unknown. The authors performed a retrospective, matched case-control study to examine associations between acquired, in-hospital risk factors and development of VTE. They identified thermally injured patients who were diagnosed with VTE over an 8.5-year period at our institution. VTE patients were matched 2:1 with non-VTE controls based on age, TBSA burned, and presence of inhalation injury. Retrospective chart review identified recognized VTE risk factors such as infectious complications, operative procedures, or central venous access. For each VTE patient and their matched controls, data analysis was limited to the time period before VTE developed. This allowed examination of differences in the pre-VTE hospital course between patients with and without VTE. Nineteen patients with VTE were matched 2:1 with non-VTE controls. No significant differences were present between groups for age, gender, TBSA, inhalation injury, body mass index, ventilator days, and intensive care unit or hospital length of stay. Patients with VTE had significantly more operations (3.7 vs 1.9, P = .038), were more likely to have pneumonia (73.7 vs 43.2%, P = .031), or have central venous line insertion (84.2 vs 51.4%, P = .016) in the pre-VTE period. No significant differences were present for positive blood cultures, urinary tract infections, or burn wound infection between groups. Our study demonstrates that number of operations, pneumonia, and central venous access are significantly associated with VTE after thermal injury. These in-hospital risk factors should be incorporated into future risk assessment models.