Association of surgical start timing with longitudinal patient-reported urinary recovery after robot-assisted radical prostatectomy

To examine the association between surgical start timing and longitudinal patient-reported urinary health-related quality of life (HRQOL) after robot-assisted radical prostatectomy (RARP). This single-center retrospective cohort included eligible patients who underwent RARP during the study period from 2013 through July 2026. Patients were eligible if they had a baseline Expanded Prostate Cancer Index Composite (EPIC) urinary summary score and at least one postoperative score through 12 months. Surgical start was classified as morning (AM; incision before 12:00) or afternoon (PM; incision at or after 12:00). Exact incision time was also analyzed continuously when available. The primary outcome was the 12-month urinary summary score, analyzed using a covariate-adjusted linear mixed-effects model. The cohort included 725 patients (AM, n = 385; PM, n = 340) and 2,586 postoperative observations. The adjusted PM-minus-AM difference at 12 months was − 1.38 points (95% confidence interval [CI], − 3.90 to 1.14; p = 0.283), with no clear evidence of a different recovery trajectory (interaction p = 0.157). None of the four urinary subdomain contrasts showed a clear 12-month difference after false-discovery-rate adjustment (all adjusted p = 0.430). Among 232 patients with exact incision time, each 1-hour later start was associated with a − 0.26-point difference at 12 months (95% CI, − 1.15 to 0.62; p = 0.559). In this retrospective cohort, surgical start timing was not clearly associated with patient-reported urinary HRQOL or its recovery through 12 months after RARP. These findings may provide useful information when counseling patients who are concerned about afternoon surgery.