Enhanced Recovery After Surgery (ERAS) Program (EP) is widely applied to obtain a reduction in post-operative length of hospital stay and a faster restoration of pre-operative patient conditions. However, in Western countries, adherence to EP in liver surgery is still difficult to achieve due to deep-rooted traditional practices. In our Institute, since 2019, EP has been applied pursuing 18/23 items identified by 2016 guidelines. At all consecutive patients who underwent elective liver surgery in our Institution, EP was proposed and their adherence to ERAS items was measured before, during and after surgery. Data were retrospectively collected and analysed, particularly focusing on EP items. Primary outcome was compliance to EP, defined as at least 80% of accomplished items per patient. Secondary outcome was adherence to each ERAS item, while tertiary outcome was detecting the variables associated with program drop out.

Inclusion Criteria:

• patients candidates to surgery for benign or malignant liver disease
• liver resection with curative intent

Exclusion Criteria:

• refusal to participate at the EP
• incapability to acquire informed consent
• cognitive impairment that can prejudice the patient comprehension of the EP
• liver surgery with palliative or diagnostic intent or non-resective liver surgery
• emergency surgery

126 patients were consecutively enrolled from January 2019 to July 2021