• Lynne Moore, Henry Thomas Stelfox, David Evans, Sayed Morad Hameed, Natalie L Yanchar, Richard Simons, John Kortbeek, Gilles Bourgeois, Julien Clément, François Lauzier, and Alexis F Turgeon.
• Department of Social and Preventative Medicine, Université Laval, Québec, Canada.
• Ann. Surg. 2018 Jan 1; 267 (1): 177-182.

ObjectiveTo assess the variation in hospital and intensive care unit (ICU) length of stay (LOS) for injury admissions across Canadian provinces and to evaluate the relative contribution of patient case mix and treatment-related factors (intensity of care, complications, and discharge delays) to explaining observed variations.BackgroundIdentifying unjustified interprovider variations in resource use and the determinants of such variations is an important step towards optimizing health care.MethodsWe conducted a multicenter, retrospective cohort study on admissions for major trauma (injury severity score >12) to level I and II trauma centers across Canada (2006-2012). We used data from the Canadian National Trauma Registry linked to hospital discharge data to compare risk-adjusted hospital and ICU LOS across provinces.ResultsRisk-adjusted hospital LOS was shortest in Ontario (10.0 days) and longest in Newfoundland and Labrador (16.1 days; P < 0.001). Risk-adjusted ICU LOS was shortest in Québec (4.4 days) and longest in Alberta (6.1 days; P < 0.001). Patient case-mix explained 32% and 8% of interhospital variations in hospital and ICU LOS, respectively, whereas treatment-related factors explained 63% and 22%.ConclusionsWe observed significant variation in risk-adjusted hospital and ICU LOS across trauma systems in Canada. Provider ranks on hospital LOS were not related to those observed for ICU LOS. Treatment-related factors explained more interhospital variation in LOS than patient case-mix. Results suggest that interventions targeting reductions in low-value procedures, prevention of adverse events, and better discharge planning may be most effective for optimizing LOS for injury admissions.

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