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Objective: This retrospective cohort study analyzed factors determining perioperative mortality in patients with ruptured abdominal aortic aneurysm (rAAA) undergoing open surgical repair (OSR) or endovascular aneurysm repair (EVAR). Materials and Methods: 147 rAAA patients who underwent OSR (n = 37) or EVAR (n = 110) between 2000 and 2017 were included. Demographic data, intraoperative details, and perioperative complications were assessed. Logistic regression analysis identified factors associated with perioperative mortality. The primary endpoint was perioperative mortality rate, and the secondary endpoint focused on factors determining 30-day mortality. Results: Overall perioperative mortality was 19.04% (28/147), with 8.1% (3/37) for OSR and 22.7% (25/110) for EVAR (p = 0.139). The non-survived group had more unfit patients (82.1% vs. 47.9%, p = 0.002), higher preoperative serum creatinine levels (1.8 ± 1.74 vs. 1.4 ± 5.89, p = 0.011), and higher rates of aortic balloon usage (64.3% vs. 22.7%, p<0.001) and cardiac arrest 28.6% vs. 3.4%, p < 0.001). Multivariable analysis identified age > 80 years (adjusted odds ratio [aOR] 9.785, p=0.003), unfit patient status (aOR, 3.35, p = 0.028), aortic balloon usage (aOR, 5.54, p = 0.036), postoperative myocardial infarction (aOR, 13.995, p < 0.001), postoperative congestive heart failure (aOR, 15.22, p = 0.038), and abdominal compartment syndrome (aOR, 23.397, p < 0.001) as independent predictors of 30-day mortality. Conclusion: No significant difference in perioperative mortality was found between OSR and EVAR in rAAA patients. Several independent factors predicting 30-day mortality were identified, providing valuable insights for clinicians in predicting outcomes and improving patient care in rAAA cases. [ABSTRACT FROM AUTHOR]