Asher Hayes
Introduction
Robotic-Assisted Laparoscopic Prostatectomy (RALP) is evolving towards a day-case model to reduce NHS bed pressures and surgical backlogs. Same-day discharge (SDD) RALP offers potential cost and efficiency benefits without compromising patient safety or satisfaction. This audit evaluates perioperative modifications to support transition towards SDD.
Methods
A retrospective audit of 57 RALP procedures (January 2025 to February 2026) compared outcomes between general anaesthesia (GA, n=36) and combined general anaesthesia with spinal (GA+SP, n=21). Outcomes assessed included pain scores, opioid and antiemetic requirements, mobilisation time, and length of stay (LOS).
Results
Mean LOS was 39.4 hours (GA) and 42.4 hours (GA+SP). The principal barrier to early discharge was delayed physiotherapy-led mobilisation (29.4 vs. 27.6 hours). Pain control was comparable between groups, with a reported median of 0 across both GA and GA+SP in recovery (0.9 vs. 1.16) and on the ward (1.05 vs. 1.40). Antiemetic use was marginally higher in the GA+SP group (14.3% vs. 11.1%). Opioid requirements were comparable between groups.
Conclusion
RALP can be delivered efficiently with effective pain control through optimised surgical, anaesthetic, and postoperative strategies. With structured perioperative pathways and improved multidisciplinary coordination, SDD is achievable. To realise economic and capacity benefits, this centre will implement preoperative education, an enhanced ERAS pathway, and targeted improvements in physiotherapy and nursing workflows to pilot SDD RALP.
Authors
Asher Hayes, The University of Nottingham, Nottingham, United Kingdom
Yogit Wagh, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom
Sachin Doijodenagaraj, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom
Elizabeth Dreher, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom
Idil Dhabahaye, The University of Nottingham, Nottingham, United Kingdom
Priyansha Sheel, The University of Nottingham, Nottingham, United Kingdom
Aly Elmeligy, The University of Nottingham, Nottingham, United Kingdom