Objectives: We examined the operative results for ruptured abdominal aortic aneurysm (RAAA) and influences of diagnosis procedure combination (DPC) on medical service costs in the surgical treatment of RAAA. Methods: The records of 16 patients who underwent RAAA repair between March 2007 and April 2010 in our hospital were reviewed. The operative data according to perioperative factors, and the postoperative clinical courses in patients with (n=9, group G) or without (n=7, group B) complications were assessed and compared between the groups. The comparison of the cost reimbursed through the DPC system (DPC-f) with that received via the conventional cost compensation system (CCC-f) in, and between the groups was also evaluated. Results: The hospital mortality and morbidity rates were 18.8% and 43.6%, respectively. Neither preoperative or intraoperative factors between the groups were significantly different. Durations of mechanical ventilation, intensive care unit stay and hospital stay were significantly longer in group B than in group G. The major postoperative complications in group B were renal failure (n=5), respiratory failure (pneumonia, n=3, acute respiratory distress syndrome, n=1) and organ ischemia (severe lower limb ischemia, n=2, colon necrosis, n=2). The causes of surgical death were deep shock (n=1) and colon necrosis (n=2). One patient with a complication of abdominal compartment syndrome survived by optimal decompressive laparotomy and secondary abdominal closure. Both DPC-f and CCC-f were significantly higher in group B than in group G. DPC-f was significantly lower than CCC-f in both groups. The difference, that is [DPC-f-CCC-f], was significantly larger in group B than in group G (p=0.04), resulting in a decrease in medical income for the hospital. Conclusion: The operative results for RAAA were not considered satisfactory. These findings emphasized that optimal perioperative management is important to prevent and control severe complications and prolonged hospitalization after surgical treatment of RAAA, which is strongly related to organ ischemia and failure induced by deep shock or low output syndrome. Medical economical assessments suggested that it might be necessary to reconsider the indications of the DPC system in the calculation of fees for medical services in the surgical treatment of RAAA.