A Comparative Analysis of Opioid Overdose Hospitalizations Pre- and Post-Pandemic: Insights from the National Inpatient Sample Database.

Abstract

Background: The COVID-19 pandemic disrupted healthcare systems, affecting opioid overdose-related hospitalizations. National data examining how demographic and clinical outcomes evolved during this period, particularly by overdose intent, remain limited.

Methods: Using the National Inpatient Sample (2018-2021), we identified adult hospitalizations for opioid overdose using ICD-10 codes and categorized cases as intentional, unintentional, or unspecified. Patients were grouped into pre-COVID (2018-2019) and post-COVID (2020-2021) cohorts. Multivariable logistic and linear regression models adjusted for patient- and hospital-level factors evaluated demographic differences, complications, and outcomes.

Results: Among 293,810 hospitalizations, intentional overdoses decreased over time, while unintentional overdoses remained predominant. Post-COVID hospitalizations had higher odds of, sudden cardiac arrest (5.53% vs 4.52%; aOR 1.18, 95% CI 1.09-1.27), vasopressor use (aOR 1.12, 95% CI 1.01-1.24), and cardiac dysrhythmias (aOR 1.08, 95% CI 1.02-1.14), with no mortality difference (aOR 1.00, 95% CI 0.92-1.08).Intentional overdoses were more common among younger females and associated with better clinical outcomes. Compared with unintentional overdoses, intentional cases had lower odds of in-hospital mortality (1.86% vs 4.90%; aOR 0.47, 95% CI 0.40-0.55), sudden cardiac arrest (aOR 0.26, 95% CI 0.22-0.31), invasive ventilation (aOR 0.80, 95% CI 0.76-0.85), and anoxic brain injury (aOR 0.41, 95% CI 0.35-0.47).

Conclusions: Despite a decline in opioid overdose-related hospitalizations, unintentional overdoses remained the dominant and more severe presentation. The increase in post-COVID complications suggests a shift toward greater clinical acuity, placing additional strain on inpatient healthcare resources.