OBJECTIVES Throughout Europe, economic conditions are forcing healthcare systems to reduce costs. One primary driver of healthcare costs is hospital length of stay (LOS). This study sought to determine which European countries have been most successful at reducing their average LOS for five inpatient admissions. This research also sought to quantify the potential savings for countries that have not been as successful in reducing their average LOS if they can align with their peers.  METHODS A review of hospital LOS and cost per day of hospital stay data was conducted in five European countries (France, Germany, Italy, Spain and the United Kingdom), utilizing data published by the World Health Organization (WHO). Additionally, hospital payment systems were assessed in each country through published research to understand systemic motivations of healthcare providers with regards to LOS. RESULTS Substantial variability exists in average LOS for the studied admissions. The greatest variability was in breast cancer, with average stays ranging from 4.36 days in the UK to 11.01 days in Germany. The average LOS for three admissions (single spontaneous delivery, cataracts, and pneumonia) are relatively similar across countries. However, the average LOS in Germany for malignant neoplasm of the breast and acute myocardial infarction are significantly higher than the other four countries. There is little variability, however, in average costs per bed-day in the target countries. A review of payment mechanisms for inpatient stays revealed that hospitals are financially incentivized to minimize LOS in all five countries.  CONCLUSIONS Additional research is needed to understand the reason for the discrepancy between German stays and the other four countries. While there are many potential reasons for the differences, should Germany align their average LOS for malignant neoplasm of the breast and acute myocardial infarction with the other four countries, they could save €744 million per year.