Upstream factors in the enhanced recovery after surgery (ERAS) pathway significantly influence postoperative compliance in liver resection patients, suggesting that focusing on these elements can improve outcomes.

• Compliance increased from 32.4% at baseline to higher levels as upstream elements like avoiding bowel prep and preoperative carbohydrate loading were successfully implemented.
• Four key preoperative interventions were strongly associated with improved compliance: avoiding bowel preparation, preoperative carbohydrate loading, thrombosis prophylaxis, and avoiding drainage at the resection site.

Surgeons should consider prioritizing these preoperative ERAS elements to enhance overall patient compliance and recovery.