Purpose: To compare in a population-based analysis the in-hospital mortality and complications following endovascular aneurysm repair (EVAR) vs. open repair in patients transferred for the management of ruptured abdominal aortic aneurysm (RAAA). Methods: Interrogation of the 2003-2007 Nationwide Inpatient Sample database identified 271 patients (205 men; mean age 71.7 years) who were transferred for RAAA treatment. Demographic, patient, and hospital characteristics were analyzed. Hierarchical multivariate logistic regression analyses were employed to identify predictors of in-hospital mortality and complications; results are presented as the odds ratio (OR) and 95%% confidence interval (CI). Results: In comparison to open repair (n == 207), endovascular repair (n == 64) was associated with lower in-hospital mortality (36%% vs. <18%%, p<0.01) and a lower complication rate (78%% vs. 66%%, p<0.05). Transferred RAAA patients undergoing EVAR had lower in-hospital mortality (OR 0.21, 95%% CI 0.09 to 0.49, p<0.01) and fewer complications (OR 0.49, 95%% CI 0.26 to 0.95, p<0.05) than transferred patients having open repair. Conclusion: Compared to open repair, EVAR led to superior short-term clinical outcomes in transferred RAAA patients. In this clinical situation, transfer of stable RAAA patients to institutions capable of performing EVAR is recommended. [ABSTRACT FROM AUTHOR]