SummaryWe investigated whether the type of anaesthesia affects mortality and length of stay after non-traumatic major lower extremity amputations. A total of 1365 eligible patients who were operated on between 2002 and 2010 were included in the final analysis. Propensity score matching was used to produce 475 matched pairs of patients undergoing operation with either general or regional anaesthesia. We found that 30-day mortality was significantly greater in the general anaesthesia group compared with the regional anaesthesia group, with an odds ratio (95% CI) of 1.5 (1.0-2.3) in the total matched population and 4.2 (1.3-13.4) in a high-risk subgroup. The median (IQR [range]) length of postoperative hospital stay was significantly less in the patients of the high-risk subgroup who had general anaesthesia at 15 (7-21 [1-101]) days compared with 25 days (10-37 [0-78]) for those who had regional anaesthesia (p = 0.027). The results of our study suggest that 30-day mortality is significantly higher in patients undergoing major lower extremity amputations under general anaesthesia compared with regional anaesthesia. The choice of an appropriate anaesthetic technique is usually made by the anaesthesiologist after taking into account the patient's medical condition, operative factors, surgical requirements, skills of the anaesthesiologist and the preferences of the patient. Many of these decisions are based on previous experience and expert opinion. The fact that the anaesthetic technique can have repercussions beyond the traditional peri-operative period is only now being realised [1]. This new realisation has made intra-operative anaesthetic choice even more complex, requiring a more robust level of evidence to guide decision making than just expert opinion alone.The effect of anaesthetic technique on postoperative mortality has been studied in the past in various types of surgery [2,3], but the heterogeneity of the surgical population makes generalisations about the effect of anaesthesia on mortality inappropriate.Patients undergoing non-traumatic major lower extremity amputation (MLEA) are known to have a large number of comorbidities and an associated 30-day mortality ranging between 8% and 32% [4][5][6][7][8]. Cardiovascular complications make up the most common cause of postoperative mortality among these patients [7,9]. Although there is some evidence indicating that 612 Anaesthesia

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