OBJECTIVES: The objective of this study was to evaluate whether international pediatric patients differed from domestic patients in length of stay and resource utilization for elective inpatient surgical procedures. METHODS: Using a retrospective matched cohort design, we examined the records of pediatric patients with inpatient elective surgical procedures with a primary payment source of self-pay cash-in-full or commercial insurance and discharged between January 1, 2011 and October 15, 2015 from an academic medical center member of the Clinical Database of Vizient, Inc. (formerly the University HealthSystem Consortium). Generalized linear regression models were fit to test the association between geographic region of home residence (international or domestic) and hospital length of stay, total hospital cost of care and total hospital cost per day. RESULTS: Of the 635 international patient discharges, 581 (91.5%) matched to a domestic patient discharge. Of the 581 international patient discharges the ten most frequent MS-DRGs represented 36.8% of discharges. The mean length of stay was 10.4 days for international and 8.6 days for domestic patients (p = 0.090), mean total cost was $53,486 for international patients and $50,901 for domestic patients (p = 0.698), and mean total cost per day was $6,851 for international patients compared with $7,290 for domestic patients (p = 0.314). After controlling for patient demographic and clinical characteristics, international patients stayed 19% longer (1.65 days p<0.001) than domestic patients. There was no significant difference in total hospital cost by geographic region of home residence, and international patients had $534 lower cost per day (p = 0.033) than domestic patients. CONCLUSIONS: International pediatric surgical patients stayed longer than domestic surgical patients, but did not cost significantly more overall. Further study is warranted to better understand the differences in care needs for international pediatric patients.