Objective: Deep brain stimulation (DBS) is an established surgical therapy for movement disorders, epilepsy, and psychiatric conditions, yet remains underutilized due to perceived risks. We therefore endeavored to compare the safety of DBS to other common elective procedures to provide context for its relative risk.
Methods: This retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, encompassing diverse referral and community hospitals across the United States from 2015 to 2021. Patients with DBS were compared with those receiving one of the 16 most common elective procedures. The primary outcome of interest was the weighted odds of any postoperative complication at 30 days. Secondary outcomes included risk of readmission, reoperation, and discharge disposition. Logistic regression with inverse probability of treatment weighting (IPTW) based on propensity scores adjusted for baseline group heterogeneity.
Results: We identified 2,853,662 patients for analysis, including 4,749 DBS procedures. After IPTW adjustment, patients with DBS experienced lower 30-day complication rates compared with other procedures (1.3% vs 4.1%, OR = 0.32, 95% confidence interval [CI] = 0.25-0.41, p < 0.0001). Readmission rates did not differ significantly (2.2% vs 2.6%, OR = 0.84, 95% CI = 0.69-1.02, p = 0.08). DBS cases had higher odds of discharge home (98.7% vs 96.3%, OR = 2.94, 95% CI = 2.27-3.82, p < 0.0001) and lower reoperation rates (0.7% vs 1.3%, OR = 0.50, 95% CI = 0.35-0.72, p = 0.0002).
Interpretation: DBS demonstrates a favorable safety profile with substantially lower complication rates compared with the most widely performed elective surgeries. These findings support broader consideration of surgical referral for appropriate DBS candidates. ANN NEUROL 2026;99:1239-1250.
© 2026 American Neurological Association.