The morbidity and mortality of an raaa remain prohibitive, despite immediate surgical repair and aggressive postoperative management. the mortality rates of patients arriving at the hospital have ranged from 32% to 80%.1- 11 Such a wide range in reported mortality is due to significant variations in the hemodynamic status of the patient at presentation. in view of the high mortality rate associated with the repair of raaas, several studies have tried to identify factors predictive of a fatal outcome. a mortality of more than 92% was identified in patients older than 80 years; the rate was 68% in patients 80 years and younger.11 Donaldson et al4 observed that the mortality was higher in patients older than 76 years. the presence of cardiac disease, chronic obstructive pulmonary disease, and chronic renal failure (creatinine levels >3.0 mg/dl) correlated with poor outcome.4,5 Mortality was also higher in those with a free intraperitoneal rupture and in those with suprarenal extension of the aneurysm.4,5 Hypotension on arrival in the ed (blood pressure <80 mm hg) and a low hct correlated with poor outcome as well.15,16 A delay in making the correct diagnosis in the ed and preoperative cardiac arrest were associated with fatal outcome in many patients.6 The mortality was reported to be 47% by wakefield et al5 if the operative procedure took more than 5 hours, and 33% when the repair could be completed in less than 4 hours. in our series, the operative time was shorter in the late group, without any improvement in mortality in this group (P = .02). intraoperative blood loss of more than 11 000 ml, an intraoperative transfusion of more than 17 u of packed cells, and the administration of more than 7000 ml of fluid in the or was associated with a mortality of 57%4; however, we did not find any difference in the outcome among patients receiving 17 u or less vs those receiving more than 17 u of packed cells intraoperatively. chen et al,17 using a multivariate stepwise logistic regression analysis, found that coagulopathy, ischemic colitis, persistent shock, delayed transfer to the or, advanced age, a perioperative myocardial infarction, and renal failure were independent predictors for postoperative death. bradbury et al18 observed that a low platelet count at the completion of the operation was associated with a poor prognosis. by stepwise multiple regression analysis, we observed that age younger than 70 years, an hct of more than 35%, and an ed to or time of less than 120 minutes were associated with improved survival rates; however, the presence of a chronic obstructive or a cardiac disease or female sex was not associated with an adverse outcome. rutledge et al,12 from a statewide review of patients in north carolina, reported a mortality of 54% for raaa repair, and found that the survival rate was better in larger hospitals with more than a 100-bed capacity. they also reported an improved patient survival rate with increasing surgeon experience (determined by number of cases). katz et al19 reported a mortality of 49.8% from a statewide report of raaas in michigan. dardik et al13 reported an operative mortality of 47.4% from a database of 527 patients in maryland from 1990 to 1995. operative mortality rates increased significantly with advancing age; however, the operative mortality was lower when the repair was performed by high-volume surgeons (ie, those performing >10 raaa repairs in 5 years).13 Ouriel et al9 reported that the surgeon's experience (5 years of practice and 2 aneurysm resections per year) did not affect the mortality associated with an raaa repair; however, chronic renal failure, chronic obstructive pulmonary disease, and unstable hemodynamic status correlated with poor prognosis. katz and kohl1 reported an overall in-hospital mortality of 57% from 3 primary care hospitals in a community setting, and concluded that surgical experience and avoidance of technical errors significantly impacted the survival of patients with an raaa. they identified 15 major technical errors (6 venous injuries, 4 juxtarenal aortic injuries, 4 intraoperative anastomotic failures, and 1 intraoperative graft occlusion), and noted a 43% mortality.