title: Examination of hospital length of stay in Canada among patients with acute bacterial skin and skin structure infection caused by methicillin-resistant Staphylococcus aureus.
abstract: OBJECTIVE
  Skin infections, particularly those caused by resistant pathogens, represent a clinical burden. Hospitalization associated with acute bacterial skin and skin structure infections (ABSSSI) caused by methicillin-resistant Staphylococcus aureus (MRSA) is a major contributor to the economic burden of the disease. This study was conducted to provide current, real-world data on hospitalization patterns for patients with ABSSSI caused by MRSA across multiple geographic regions in Canada.
  
  
  METHODS
  This retrospective cohort study evaluated length of stay (LOS) for hospitalized patients with ABSSSI due to MRSA diagnosis across four Canadian geographic regions using the Discharge Abstract Database. Patients with ICD-10-CA diagnosis consistent with ABSSSI caused by MRSA between January 2008 and December 2014 were selected and assigned a primary or secondary diagnosis based on a prespecified ICD-10-CA code algorithm.
  
  
  RESULTS
  Among 6,719 patients, 3,273 (48.7%) and 3,446 (51.3%) had a primary and secondary diagnosis, respectively. Among patients with a primary or secondary diagnosis, the cellulitis/erysipelas subtype was most common. The majority of patients presented with 0 or 1 comorbid condition; the most common comorbidity was diabetes. The mean LOS over the study period varied by geographic region and year; in 2014 (the most recent year analyzed), LOS ranged from 7.7 days in Ontario to 13.4 days in the Canadian Prairie for a primary diagnosis and from 18.2 days in Ontario to 25.2 days in Atlantic Canada for a secondary diagnosis. A secondary diagnosis was associated with higher rates of continuing care compared with a primary diagnosis (10.6%-24.2% vs 4.6%-12.1%).
  
  
  CONCLUSIONS
  This study demonstrated that the mean LOS associated with ABSSSI due to MRSA in Canada was minimally 7 days. Clinical management strategies, including medication management, which might facilitate hospital discharge, have the potential to reduce hospital LOS and related economic burden associated with ABSSSI caused by MRSA.
authors: Global Health Outcomes, Merck & Co, Inc., Kenilworth, NJ, USA.
authors: Michele H
authors: MH
authors: Potashman
authors: Evidera, Lexington, MA, USA.
authors: Michael
authors: M
authors: Stokes
authors: Evidera, Lexington, MA, USA.
authors: Jieruo
authors: J
authors: Liu
authors: Global Health Outcomes, Merck & Co, Inc., Kenilworth, NJ, USA.
authors: Robin
authors: R
authors: Lawrence
authors: Global Health Outcomes, Merck & Co, Inc., Kenilworth, NJ, USA.
authors: Linda
authors: L
authors: Harris
keywords: ABSSSI; Canadian provinces; LOS; MRSA; hospital outcomes; time trends