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A Comparative Analysis of Opioid Overdose Hospitalizations Pre- and Post-Pandemic: Insights from the National Inpatient Sample Database
Journal article   Open access   Peer reviewed

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

Hassan Shakir, Niloy Ghosh, Mohammed A. Quazi, Tom Limanovich, Abdul R. Awan, Humza Saeed, Adeel Nasrullah, Christopher R. Smith and Abu B. Sheikh
Journal of community hospital internal medicine perspectives, v 16(4), pp 62-72
17 Jul 2026
DOI: https://doi.org/10.55729/2000-9666.1632
PMID: 42631304
url
https://doi.org/10.55729/2000-9666.1632View
Published, Version of Record (VoR) Open

Abstract

General & Internal Medicine Life Sciences & Biomedicine Medicine, General & Internal Science & Technology
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.

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