OBJECTIVES: The purpose of this study was to examine the incidence of bleeding-related complications and blood product transfusions and their impact on hospital length of stay (LOS) and total cost in various inpatient surgical cohorts.  METHODS: A retrospective analysis was conducted using Premier’s Perspective hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ or knee/hip replacement) during 2006-2007 were identified based on ICD-9-CM procedure codes.  For each specialty, the rate of bleeding-related complications (including bleeding event, interventions to control for bleeding and blood product transfusions) were examined, and hospital costs and length of stay (LOS) were compared between surgeries with versus without bleeding-related complications. Incremental costs were estimated using a multivariate analysis adjusting for demographics, hospital characteristics and other baseline characteristics.    RESULTS: A total of 103,922 cardiac, 216,380 vascular, 142,698 non-cardiac thoracic, 45,824 solid organ, 362,797 general, 12,271 reproductive organ and 247,287 knee/hip replacement surgeries were identified.  Overall, the rate of bleeding-related complications was 42.2% and ranged from 27.5% to 47.5% for general and cardiac surgeries, respectively. Incremental LOS associated with bleeding-related complications or transfusions across all specialties averaged 5.5 days and ranged from 1.3 to 9.6 days for knee/hip replacement and non-cardiac thoracic surgeries, respectively. The incremental cost per hospitalization associated with bleeding-related complications was highest for vascular ($15,296) followed by solid organ ($14,072), non-cardiac thoracic ($13,715), cardiac ($10,279), general ($4,364), reproductive organ ($8,200) and knee/hip replacement ($3,025).   CONCLUSIONS: This study demonstrates the high incidence of and increased economic burden associated with bleeding-related complications and transfusions among inpatient surgical patients. Given the high burden, implementation and economic impact assessment of blood conservation strategies should be further evaluated.