Purpose: Although autologous blood procurement has become a standard of care in elective surgery, recent studies have questioned its cost- effectiveness. We therefore reviewed our 3-year experience with intraoperative cell salvage in patients who underwent elective abdominal aortic aneurysm repair. Methods: A 3 year retrospective chart review of elective abdominal aortic aneurysm (infrarenal and suprarenal) repair was performed. Transthoracic repairs were excluded. Results: Estimated blood lost was 1748 ± 1236 ml, or 35% of baseline blood volume (5012 ± 689 ml). Overall, 164 (89%) received red blood cell (RBC) transfusions (3.5 ± 2.0 U/patient). The cost per patient for cell salvage was $315 ± $97, representing 31% of all RBC costs and 24% of total blood component costs. Mean salvage volume infused was 578 ± 600 ml; at a mean hematocrit level of 55.7% the RBC volume infused from salvage during surgery was 313 ± 328 ml (representing 27% of total RBC volume lost during the hospital stay). This mean RBC volume salvaged represented the equivalent of 1.6 blood bank RBC units. The mean blood bank costs saved by using cell salvage was $248, or 79% of the $315 actually spent for salvage. We found no decrease in percentage of patients undergoing transfusion until salvage volumes that were infused exceeded 750 ml, or the equivalent of two blood bank units; all of these patients who benefitted had estimated blood lost ≤ 1000 ml. Conclusions: We conclude that use of intraoperative cell salvage was most beneficial for patients who had estimated blood loss greater than or equal to 1000 ml and cell salvage volumes infused greater than or equal to 750 ml. Patients who are estimated to lose less than 1000 ml receive little benefit yet incur substantial costs from intraoperative cell salvage.