Objective To evaluate the effect of infusion of fresh or old red cell suspension and different volume of blood transfusion on the prognosis of patients with surgical.Methods Totally 273 patients undergoing the first elective orthopedic surgery from the first af-filiated hospital of Xinjiang medical university from January 2013 to December were enroued.Accepting criteria induded 15-65years ,no limitation for race and gender, ASAⅠ-Ⅲgrade, need of transfusion of red blood cell≤10U.According to the oldest storage age of any RBCs transfused:patients who received only RBCs stored for≤14 days were grouped to the Fresh, those who only RBCs stored for >14 days were grouped to the Old.According to the volume of blood transfusion were divided into ≤2U, 3 -4U, ≥5U three groups. Record The demographic and clinical features of the patients were recorded and length hospital stay, the rate of ICU shift, pulmonary in-fection occurred, postoperative transfusion rate, incision healing condition and major adverse cardiovascular events of to compared two groups.Results There was statistical differences in postoperative 24h hemoglobin , postoperative transfusion rate, pulmonary infection occurred and major adverse cardiovascular events between the Fresh and Old group ( P<0.05) .A trend of increasing complication rate was observed with more units transfused, especially≥5U.Conclusion Infusion of old red cell suspension has a certain impact on the surgery patients′postoperative complications.The volume of blood transfusion is consistently associated with adverse outcome.