"A Mixed-Methods Study of Patient Satisfaction and Experience After Same-Day Discharge for Holmium Laser Enucleation of the Prostate (HoLEP)".

OBJECTIVE: Same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) yields postoperative outcomes comparable to overnight admission (OA). However, the patient perspective on SDD has been largely overlooked. This study is the first to assess patient satisfaction and perceived experience after HoLEP, comparing SDD to OA. METHODS: We performed a mixed-methods study of adults undergoing HoLEP at an academic medical center between 2018 and 2023. Participants from the prospective Registry of Bladder Outlet Obstruction (ReBOOT) completed the validated Surgical Satisfaction Questionnaire (SSQ-8). Fifteen patients from each discharge pathway (SDD and OA) were interviewed. Two blinded reviewers independently coded the interview transcripts and conducted thematic analysis using Dedoose. RESULTS: Of 413 patients, 257 responded (62%), including 146 (57%) OA and 111 (43%) SDD. Surgical satisfaction was similar between groups (84 vs 83.3, p=0.82). Positive experiences were driven by provider reassurance, individualized care, pathway familiarity, and caregiver support, whereas negative experiences reflected unmet expectations, unclear discharge education, and inadequate follow-up communication. Inadequate follow-up communication was more common among OA patients than SDD patients (87% vs 47%). CONCLUSION: SDD after HoLEP achieves patient satisfaction comparable to OA. However, surgical experiences in both pathways were significantly impacted by inadequate postoperative education, guidance, and recovery support, highlighting targets to implement SDD effectively.