OBJECTIVES: The objective of this study was to compare costs and resource utilization in prostate surgery patients with perioperative blood loss (PBL) to those who did not experience perioperative blood loss (NPBL). METHODS: Males with inpatient prostate surgery discharges (ICD-9-CM: 60.0, 60.12, 60.14, 60.15, 60.3, 60.5, 60.6X, 60.72, 60.73, 60.79, 60.8X, 60.93, 60.94) were identified from the Premier Perspective® Database (CY 2009 - Q2 of CY 2010). Discharges were categorized into the PBL group if they had received at least one blood transfusion (ICD-9-CM: 99.02-99.07; CPT: 36430, 35455) during the hospital stay, otherwise were included in the NPBL group. Blood transfusion was assumed to be an indicator for PBL. Groups were matched (1:1) on age, race and APR-DRG severity using propensity scores. Adjusted estimates for costs (total and departmental), days of stay in hospital (LOS), ICU, and operating room (OR) time in minutes were compared between the PBL and NPBL groups using generalized linear model (GLM) with gamma distribution and log link. RESULTS: A total of 18,681prostate surgery discharges were identified. Of those, 1176 (6.3%) required at least one blood transfusion perioperatively. After matching, 1168 discharges were retained in each group for the final analysis. Adjusted mean total costs were significantly higher for the PBL group compared to NPBL group ($16,757 vs. $12,712, p<0.0001). Mean adjusted costs associated with room & board, surgery and pharmacy between PBL and NPBL group and were also significantly higher for the PBL group (all p<0.05). Compared to the NPBL group, the PBL group had higher mean LOS (5.8 days vs. 3.6 days), and longer OR time (232 minutes vs. 211 minutes) (both p<0.05).   CONCLUSIONS: Perioperative blood loss for prostate surgery patients adds significant burden to hospital costs and resources. Adopting strategies aimed at minimizing PBL during prostate surgery process may conserve valuable medical resources.