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Women experience worse outcomes after repair of ruptured abdominal aortic aneurysms (rAAAs). However, it is unknown whether women are more often turned down for repair as a result. Therefore, we evaluated the characteristics of patients who had presented with rAAAs and those who had not undergone operative intervention stratified by sex.Methods: We evaluated all patients who had presented with a rAAA in the National Inpatient Sample Database from 2004 to 2015 and compared patients stratified by subsequent repair and sex. We used multivariate logistic regression to compare the likelihood of repair by sex and to evaluate the factors associated with patients refused repair.Results: A total of 62,399 patients had been admitted with a rAAA, 17,990 (29%) of whom were women. The women were older (79 vs 74 years; P < .001), were less likely to be white (85% vs 87%; P < .001), had higher rates of congestive heart failure (7% vs 4%; P < .0001), had lower rates of renal failure (16% vs 18%; P < .001), and had lower rates of obesity (6% vs 8%; P < .001). The women were also more likely to have Medicare (85% vs 73%; P < .001) and more likely to be treated at rural (9% vs 7%; P < .001) and smaller (8% vs 10%; P < .001) hospitals and less likely to be treated at an urban teaching hospital (54% vs 57%; P < .001). The turndown rate for women was 56% compared with just 24% for men (P < .001). Furthermore, mortality was also higher for the women who did not undergo repair (75% vs 70%; P < .001). After adjustment for differences in demographics and comorbidities, the women remained less likely to be treated for a rAAA (odds ratio, 0.55; 95% confidence interval, 0.50-0.59; P < .001; Table ). On multivariate analysis, sex was the factor most strongly associated with the odds of a patient being turned down for repair.Conclusions: Women were less likely to be treated for a rAAA even after adjustment for age, baseline demographics, and hospital characteristics. Women also had higher mortality even when treated medically. Further investigation is needed to elucidate this discrepancy between the sexes.