Objective, To determine the operative mortality of ruptured abdominal aortic anenrysm (RAAA) in The Netherlands. Design. Retrospective population-based study of nation-wide in-hospital mortality of RAAA repair. Methods. Data were obtained from a national registry for medical diagnosis and procedures. In-hospital mortality of RAAA repair, defined as death during hospital admission irrespective of the cause of death, was determined in the period 1991-2000. Variables of potential influence oil in-hospital mortality, including age, gender, date of surgery and hospital type (0-399 beds, >= 400 beds or university hospitals) were studied in a multivariate analysis. Results. The overall in-hospital mortality of RAAA repair in 5593 patients in the 10-year period was 41% (95% confidence interval: 40-42%). In the multivariate analysis, age and hospital type were the most important independent predictors for in-hospital mortality. Gender, year and season of surgery could not be identified as significant risk factors. Conclusions. Over a recent decade, in-hospital mortality of RAAA repair remained Unchanged at 41%. Age and hospital class were the most important independent risk factors.