Jolissaint JS, et al. - From the Veterans Affairs Surgical Quality Improvement Program national data set, researchers studied 14,890 patients undergoing elective above-knee or below-knee amputation for rest pain, tissue loss, or gangrene in order to develop a simple risk prediction model that may help identify factors associated with 30-day morality after lower extremity major amputation for ischemic vascular disease. Death of 4.6% (n = 453) was reported in the derivation data set. Using eight easily obtainable clinical metrics (preoperative do not resuscitate order, congestive heart failure, age >80 years, chronic renal insufficiency, above-knee amputation, dependent functional status, coronary artery disease, and chronic obstructive pulmonary disease), they derived this risk prediction model that allowed early assessment of 30-day mortality risk of patients undergoing major lower extremity amputation for ischemic indications. They noted increased mortality with increasing risk category when internal validation of the risk score was done. For surgeons, reliable expected mortality prediction is critically important as it may assist in making recommendations in accordance with a patient's or family's goals of care.