Surgeon Preference Cards Are Draining Your Supply Budget
Outdated surgeon preference cards stock ORs with supplies that never get used. What that waste costs per case, and a data-driven way to fix it without guesswork.
Surgeon preference cards are one of the quietest, most persistent sources of waste in the OR. Every card tells the team what to pull and open for a case — and when it drifts out of date, the facility opens supplies that go straight from the sterile field to the trash, case after case. Because the waste is small per item and invisible per case, it rarely gets attention. At scale, surgeon preference cards that have rotted out of date drain a meaningful share of the supply budget. This post quantifies the problem and lays out a data-driven fix.
What a preference card is and why it rots over time
A preference card is the standing recipe for a case: instruments, supplies, sutures, and equipment for a specific surgeon and procedure. It is accurate the day it is written — and then it decays. Techniques change, products get swapped, a surgeon stops using an item but never updates the card, and nobody owns ongoing maintenance. The result is a card that still calls for things the surgeon hasn't used in two years, every one of which gets opened "just in case."
The cost of opened-but-unused supplies
The cost is larger and better-documented than most teams assume. A 2026 JAMA Surgery quality-improvement study at a large academic health system examined nearly 1,300 preference cards across hundreds of procedures and found a mean cost of about $1,294 per case in unused items — totaling roughly $3.7 million across the study period. That is supplies opened, charged, and discarded without ever being used.
Mean cost of unused items per case from outdated preference cards, totaling about $3.7M across the study.
Perez et al., JAMA Surgery, 2026
You may also see an industry figure that roughly 40 percent of preference-card supplies go unused.
On that 40% figure
The widely repeated "40% of preference-card supplies go unused" claim comes from medical-supply vendor marketing, not peer-reviewed research, and we could not trace it to a primary study — so treat it as an industry estimate, not evidence. The peer-reviewed JAMA Surgery figure above ($1,294/case in unused items) is the number to anchor on.
Why surgeon-to-surgeon variation is the real lever
The biggest opportunity is not a single bloated card — it is the variation between surgeons doing the same procedure. When five surgeons each have a different preference card for the same operation, the spread reveals which items are genuinely necessary and which are personal habit or stale defaults. That variation is the map: items some surgeons never open, but others always do, are the prime candidates for review and substitution.
A data-driven optimization approach (vs. manual guessing)
The old way to clean up cards — ask surgeons what they think they use — fails, because memory is a poor record of actual supply use. The approach that works is analytical: compare each card against the actual historical record of what was opened versus used, flag the routinely-unused items, and standardize toward lower-cost substitutes where clinically equivalent.
The results are substantial. The JAMA Surgery study's data-driven optimization cut unused-item cost by about 56 percent in colorectal surgery. A separate standardization initiative for laparoscopic cholecystectomy — analyzing per-case variation to find substitutes — saved an estimated $21,650 per year on that one procedure. The throughline: data finds the waste that surveys miss, and it does so without asking surgeons to give up anything they actually use.
How ORbit surfaces per-case and per-surgeon supply variation
Optimizing cards requires seeing supply use the way you see the rest of the OR — per case, per surgeon, per procedure, on real data. ORbit surfaces that variation: which items are opened but not used, how the same procedure differs across surgeons, and where the cost concentrates — median-based and facility-scoped, so one unusual case never sets the default. It connects supply waste to the broader cost of OR time and the efficiency metrics that matter, turning preference-card cleanup from a periodic guessing exercise into an ongoing, evidence-based one. To see your own per-surgeon supply variation, take a look at your own data.
Frequently asked questions
What is a surgeon preference card?
A surgeon preference card is the standing list of instruments, supplies, and equipment a facility pulls and opens for a given surgeon and procedure. It drives what gets stocked and opened for each case, so when it is inaccurate it directly creates either waste (opened, unused items) or delays (missing items).
How much do unused preference-card supplies cost?
A 2026 JAMA Surgery quality-improvement study at a large academic health system found a mean cost of about $1,294 per case in unused items, totaling roughly $3.7 million across the study. Data-driven optimization cut unused-item cost by about 56 percent in colorectal surgery.
How do you optimize surgeon preference cards?
By using actual historical supply-use data rather than memory — identifying items that are routinely opened but not used and removing or substituting them, while preserving what each surgeon genuinely needs. Studies show this analytical approach yields large savings, including an estimated $21,650 per year on laparoscopic cholecystectomy alone in one initiative.