OBJECTIVES: Many different methods exist for managing surgical bleeding complications (SBCs) and reducing transfusions during procedures.  The techniques utilized are dependent on institutional policies, resulting in highly variable clinical and economic outcomes between different institutions.  Our objective was to review the current literature on the quality and costs of SBC interventions to prevent and manage transfusions during surgeries and provide recommendations on future directions for quality improvement of SBCs. METHODS: A comprehensive review was conducted using Ovid, Pubmed and Scopus databases with the following keywords: quality improvement (QI), blood loss, transfusion, hemostasis and costs.  Inclusion criteria included English language, publication between 1999 and 2010, and studies where the key words were the primary endpoints.  A total of 1331 abstracts were reviewed. RESULTS: A variety of blood loss prevention techniques were identified including autologous transfusion, pharmacological and non-pharmacological interventions.  Studies suggest that bleed prevention (BP) algorithms incorporating a combination of interventions in the pre, peri and post-operative periods have the greatest potential to minimize transfusions.    Most studies assessing the economic impact of BP interventions did not include the cost of staff time, other resources beyond blood acquisition cost and longer term complications.  The exclusion of these components may underestimate the actual costs of transfusions and may have implications in assessing true cost effectiveness of BP interventions.   Consensus exists that transfusions can and should be prevented during surgery, yet there’s a lack of agreement on the optimal use of interventions for blood loss management.  CONCLUSIONS: Wide agreement on the necessity of avoiding transfusion exists, yet proven methods for minimizing SBCs are underused.  Multifaceted algorithms for minimizing SBCs show promising results where they have been used. Future QI projects should focus on reducing variation in practices through the development of evidence based standards and guidelines for the effective use of BP interventions.