For a study, researchers reviewed current transfusion practice following Adolescent Idiopathic Scoliosis (AIS) surgery and assessed risks of complication from transfusion in this cohort. Of 7,689 patients who underwent AIS surgery, 21.1% received a perioperative blood transfusion. After controlling for patient factors, a vast difference in risk-adjusted transfusion rates was presented, with a 10-fold difference in transfusion rates observed across surgeons (4.4%–46.1%) and hospitals (5.1%–50%). Patient factors did not explain any of the surgeon or hospital variations. Use of autologous blood transfusion, higher surgeon procedure volume, and more great surgeon years in practice were independently related with lower odds of allogeneic blood transfusion (P<0.001). Surgeon and hospital characteristics explained 45% of surgeon variation but only 2.4% of hospital variation. Allogeneic blood transfusion was found to be independently related to postoperative wound infection (OR=1.87, 95% CI=1.20–2.93), pneumonia (OR=1.68, 95% CI=1.26–2.44), and sepsis (OR=2.42, 95% CI=1.11–5.83). Variation exists across surgeons and hospitals in perioperative blood transfusion utilization following AIS surgery. The use of autologous blood transfusion and implementing institutional transfusion protocols might reduce unwarranted variation and potentially decrease infectious complication rates.