The routine use of abdominal drain placement is not indicated for hepatectomy without biliary reconstruction. No recommendation can be made for hepatectomy with biliary reconstruction. (1A)

Perioperative normothermia using multimodal temperature management (including circulating water garments or forced warm air) should be aintained during open and minimally invasive liver surgery. (1B)

Early oral intake with normal diet should be implemented after hepatectomy. Individualized need for artificial nutrition should be assessed for malnourished patients, patients with complications causing several days of fasting, and patients with liver cirrhosis. If artificial nutrition is considered, enteral administration should be preferred. (1A)

Insulin therapy for maintenance of normoglycemia (8.3 mmol/l) is recommended. (1A)

Use of an omental flap to cover the cut surface of the liver might reduce the risk of delayed gastric emptying after left-sided liver resection. (2C)

Postoperative laxatives, gum chewing, herbal medicine, or decoction after hepatectomy might reduce the time to first flatus or stool but do not impact the morbidity rate. Current data do not permit the recommendation of the routine use of postoperative laxatives, gum chewing, herbal medicine, or decoction to stimulate bowel movement after liver surgery. (2B)

Early mobilization (out of bed) after liver surgery should be established from the operative day until hospital discharge. No recommendation can be made regarding the optimal duration of mobilization. (1B)

A multimodal approach to postoperative nausea and vomiting should be used. Patients should receive postoperative nausea and vomiting prophylaxis with at least 2 antiemetic drugs such as dexamethasone and ondansetron. (1A)

Low central venous pressure (below 5 cm H2O) with close monitoring is recommended during hepatic transection. As maintenance fluid balanced crystalloid should be preferred over 0.9% saline or colloids. Goal-directed fluid therapy optimizes cardiac output and end-organ perfusion. This may be particularly beneficial after the intraoperative liver resection during a low central venous pressure state to restore tissue perfusion. Patients who have comorbidities and reduced cardiac function may benefit most. (1A)

Substantial literature exists supporting that audit and feedback improve outcomes in health care and surgery. Regular audit and feedback should be implemented and performed in liver surgery to monitor and improve postoperative outcomes and compliance to the ERAS program. (1B)