OBJECTIVES: Inadequate surgical hemostasis may lead to bleeding related complications and transfusion.  The aim of this analysis was to examine the incidence and costs of bleeding complications and blood product transfusions for patients undergoing inpatient surgeries.  METHODS: A retrospective analysis was conducted using Premier’s Perspective hospital database. Patients who had a procedure within a specialty of interest (i.e. cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ or knee/hip replacement) in 2006 or 2007 were identified via ICD-9 procedure codes.  For each specialty, rate of bleeding complications (including bleeding event, re-operation to control for bleeding and blood product transfusions) were examined, and cost of hospitalizations and length of stay (LOS) were compared between surgeries with versus without complications. The incremental costs were based on a multivariate analysis adjusting for demographics (e.g., age, gender, geographic region), hospital characteristics (e.g., urban versus rural, bed size) and other baseline characteristics (e.g., comorbidities, admitting diagnosis, prior hospitalization).  RESULTS: A total of 647,918 cardiac, 725,624 vascular, 227,273 non-cardiac thoracic, 139,781 solid organ, 1,586,557 general, 1,032,762 reproductive organ and 247,682 knee/hip replacement surgeries were identified.  The rate of bleeding complication was highest for knee/hip replacement (29.8%), followed by vascular (27.1%), non-cardiac thoracic (26.5%), solid organ (23%), cardiac (11.7%), general (11.4%) and reproductive organ (3.3%).  Incremental LOS associated with bleeding complications or transfusions was 11.5 days for non-cardiac thoracic, 10.5 days for solid organ, 10.2 days for vascular, 9.6 days for general and 1.3 days for knee/hip replacement surgeries. The incremental cost per case of hospitalization associated with complication was highest for non-cardiac thoracic surgeries ($27,069), followed by vascular ($26,272), cardiac ($20,261), solid organ ($18,420), general ($7,036), reproductive organ ($6,222) and knee/hip replacement ($3,246).  CONCLUSIONS: This study characterizes the increased hospital LOS and cost associated with bleeding complications and transfusions, and supports implementation of blood conservation strategies.