The show featured musical performances from Harry Gregson-Williams, Daniel Lanois, Lena Raine, and Hans Zimmer, and presentations from celebrity guests including Jonah Hill, the Russo brothers, Brendon Urie, and Christoph Waltz.

The show opened with a group speech by Nintendo's Reggie Fils-Aimé, PlayStation's Shawn Layden, and Xbox's Phil Spencer, representing the unity of the industry.

Keighley began planning for the show immediately after the previous ceremony, and spent months traveling to studios around the world to secure announcements and trailers.

It received a generally positive reception from media publications, with praise directed at the opening speech and announcements but some criticism for the focus on reveals over awards.

[2] Keighley began working on The Game Awards 2018 immediately after the previous ceremony by conducting a postmortem and booking the Microsoft Theater.

He spent months traveling to studios around the world to secure announcements and trailers, and meeting with developers to discuss how to reveal their games; he spent July and August meeting with distribution partners in China and visiting ten game studios (including FromSoftware, Kojima Productions, and PlatinumGames) in Japan, followed by some time in Europe.

Keighley began to book presenters in October, having secured developers such as Josef Fares and Jeff Kaplan by mid-month; he spoke to Peter Jackson about a collaboration but it fell through.

She worried he would spend too much time concerned about minute details;[1] Keighley agreed, noting he enjoyed the work and does not regret it but wanted to employ more people in future to shift his focus.

Keighley kept secrets from his team and senior production members only learned of some announcements in the days before the show; trailers were only listed under code names with expected durations.

[1] While all three leaders personally agreed to the speech, it took several months of negotiations before confirmation; Keighley felt it had "fallen apart" in the days before the show but "magically it came back together" in time.

[8] Schachner worried how Anthem's score would translate to an orchestral performance but, after arranging a shortened version of the game's theme, found "it started falling into place".

The developers of The Last Night were in contact with Keighley to show the game but were forced to pull out a month or two prior due to a publisher dispute.

They were judged by a panel of industry members including Jenova Chen, Todd Howard, Hideo Kojima, and Vince Zampella.

[42] BBC's Louise Blain found the amount of single-player nominees "refreshing" following discussions of ongoing games being the future of the industry.

[2] Push Square's Sammy Barker wrote the show was "very close" to hitting its ceiling and praised the blend of celebration and announcements.

[50] Shacknews staff found the show an improvement over previous years, particularly in its presentation and professionalism, though God of War's win polarized the crew.

[52] Destructoid's CJ Andriessen criticized the show's heavier focus on announcements than awards, noting trailers received more screen time than winners.

[53] The Verge's Megan Farokhmanesh highlighted the show's problematic winners, such as Ninja's use of racial expletives and refusal to stream with women and Red Dead Redemption 2's use of crunch practices.