OBJECTIVES: Previous studies estimate that up to 15% of patients who undergo cardiovascular surgery require reoperation due to bleeding. The objective of this study is to estimate the incremental cost to hospitals for reoperations where a bleeding event is the primary reason across cardiovascular reconstructive surgeries. METHODS: The study identified patients age 18 years or older with a record in the Premier hospital database between January 1, 2010 to September 30, 2012 who underwent cardiovascular reconstructive surgery. An algorithm (clinician expert rules and Premier Chargemaster data) was developed to define a reoperation where a bleeding event is the primary reason. Patients were excluded from analysis if extracorporeal circulation was utilized during the reoperation. The final sample included 294,548 patients in seven procedure groups: CABG, valve repair/replacement, AAA repair, AV access, endarterectomy, femoral-femoral/femoral-popliteal bypass, and other vascular. Multivariable modeling was performed to estimate the incremental effect on hospital costs for bleeding events that required reoperation. Regression models to control for age, gender, race, marital status, insurance type, and severity and mortality risk were performed for each category of cardiac and vascular reconstructive surgery. RESULTS: Descriptive results indicated that average hospital visit costs with no reoperation ranged between $10,832 [SD $10,731] and $48,768 [$28,368] depending on the procedure. The incremental additional cost per visit associated with a reoperation surgery for bleeding is estimated as follows by procedure group: CABG $30,951[$1,431]; valve repair $27,037 [$2,124]; AAA repair $30,145 [$1,235]; AV access $11,996 [$1,073]; endarterectomy $18,645 [$512]; fem-fem/fem-pop bypass $44,383 [$1,699], and other vascular $25,861 [$432].  CONCLUSIONS: The incremental cost of reoperations for bleeding events in cardiac and vascular reconstructive surgery varied between 63% and 179% depending on the procedure group, with the largest increase for femoral-femoral bypass procedures, CABG, AAA repair, and valve procedures respectively.