Existing risk models and predictive variables for outcome were validated on a retrospective cohort of consecutive patients with ruptured AAA. These data were also used to design novel prognostic index for outcome prediction. A prospective cohort of consecutive patients was used to further validate these scoring systems, examine novel prognostic variables and determine functional outcome. Existing risk scoring instruments for patients with ruptured AAA lack validity. Analysis of preoperative variables in patients with ruptured AAA shows that absolute surgical futility cannot be predicted. However, in-hospital hypotension (<90mmHg), reduced Glasgow Coma Scale (<15) and anaemia (<9g/dL) are associated with preoperative death. When these risk factors are equally weighted and combined to create a novel risk scoring instrument (Edinburgh Ruptured Aneurysm Score-ERAS), three discriminatory tiers of risk are demonstrable. The validity of this risk instrument is confirmed on prospective data. Examination of novel perioperative prognostic variables shows that elevated cardiac troponin I, with or without clinically apparent cardiac dysfunction, is predictive of death after ruptured AAA repair. However, although ruptured AAA are associated with an early elevation in inflammatory biomarkers, these do not appear to confer additional prognostic value. Furthermore, for the first-time, prospective study shows that patients who survive ruptured AAA repair achieve a good recovery in terms of functional outcome within six months of operation. Surgical futility cannot be predicted prior to operation in patients with AAA. However, the ERAS shows potential as a preoperative prognostic index in patients with ruptured AAA.