Technique

Surgeon preference cards: what is on one, and why yours should be different

The orthobro · 2026-08-26 · 7 min read

Search for a surgeon preference card template and you get spreadsheets, fillable PDFs, and a lot of sites that want your email address. All of them are aimed at the same reader: the person responsible for pulling supplies.

Which is correct, because that is what a preference card is. It is a supply and setup document. It exists so the right trays, implants, sutures and equipment are in the room before the patient is.

It is not a document about how to do the case, and it is not written for you.

That distinction is the whole point of this page.

What is actually on a preference card

The contents vary by hospital, but a card generally covers:

Two columns do most of the work: quantity, and open versus hold. "Hold" means it is in the room but stays unopened until asked for. Getting that column right is most of what preference card optimization means in a hospital.

Why the card in your OR is probably wrong

This is well documented, and the numbers are worse than people assume.

Roughly 40% of the supplies on a typical preference card go unused during the surgery. In one survey, surgeons themselves estimated that 26% of single-use sterile supplies opened for a case were unused by the end of it.

The reason is not mystery. In that same survey, 46.1% of surgeons said they rarely or never update their preference cards, and more than 80% expressed dissatisfaction with them. A card gets written once, the surgeon's technique drifts over ten years, and the card does not.

When systems do go back and audit them, the corrections are large. One academic health system audited and updated cards for its three most common procedures across 18 surgeons and reported total savings of $337,007, including $56,254 on open instrumentation alone. Reviews across health systems find that on average 14% of line items need a change to quantity or open/hold status.

So when you are told "it's on the card," treat that as a claim about the hospital's records, not a claim about what this surgeon will actually want today.

What the card cannot tell you

Here is the part that matters for a resident.

Even a perfectly maintained preference card answers exactly one question: what should be in the room. It is silent on everything you are actually judged on.

It will not tell you:

• The order this surgeon does the steps in, which is often not the order in the technique guide.
• Where they want you standing, and which side of the table you take.
• When they hand over and when they take back.
• The landmark they check before committing to a cut.
• The thing they stop the case over — and every surgeon has one or two.
• What they want you to have read before you scrub.

None of that is on any card, because no card was designed to hold it. It lives in the heads of the residents who have scrubbed with that attending before, and it gets passed along in hallways, badly, and then lost when they graduate.

The version worth building

So keep your own. Not a copy of the hospital's card — a different document, per surgeon, that holds what the card cannot.

A useful shape, and it is short on purpose:

Surgeon and procedure. Same pairing as the official card, because preferences are per surgeon.

Position and setup. What actually happened last time, including the small stuff — bump or no bump, arm board or arm holder, where the C-arm came in from. For shoulders, note which position and why, because that choice is a preference rather than a rule.

Sequence. The steps in the order this person does them. Just the order. You are not writing a textbook.

Hand-off points. Where you got to do something, and where you did not. This is the single most useful column over a year, because it is the record of what to ask for next time.

Stop-the-case items. The specific things that draw a correction. Two or three per surgeon. Write down the exact phrasing they used, because that is what you will recognise in the moment.

What to review before. The paper, the chapter, the video they mentioned. Whatever they expect you to have looked at.

Then update it the same day, before you leave. Not that evening, not the weekend. The details you actually need are the ones that feel too obvious to write down at the time and are gone by Thursday.

The obvious objection

Yes, this overlaps with what a good chief already carries in their head. That is not an argument against writing it down — it is an argument for it. The reason the chief has it in their head is that they scrubbed forty cases with that person. You are trying to get there in five.

And it is not a substitute for reading the case. It is what you add to reading the case, because the technique guide is identical for everyone and the attending is not.

One honest caveat

Anything you keep about a case is a record, and it sits under your institution's rules on patient information. Keep your notes about the procedure and the surgeon's preferences, not about the patient. No names, no medical record numbers, no dates that identify a person. You do not need any of that for the notes to do their job — the useful content is technique and preference, which is not patient information at all.

That is also the honest reason to keep these separate from your case log. The log is a compliance record with codes and dates. This is a training document. They answer different questions and mixing them makes both worse.