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

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.