Michael J Englesbe

Concordia University–Ann Arbor, Ann Arbor, Michigan, United States

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Publications (177)676.4 Total impact

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    ABSTRACT: The unpredictable and sometimes chaotic environment present in acute care surgery services (trauma, burn, surgical critical care, and nontrauma emergency surgery) can cause high levels of anxiety and stress that could impact a medical students' experience during their third year of medical school surgical clerkship. This negative perception perhaps is a determinant influence in diverting talented students into other medical subspecialties. We sought out to objectively identify potential areas of improvement through direct feedback and implement programmatic changes to address these areas. We hypothesized that as the changes were made, students' perception of the rotation would improve.
    Journal of Surgical Research 06/2015; DOI:10.1016/j.jss.2015.05.062 · 2.12 Impact Factor
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    ABSTRACT: We sought to determine the reliability of surgeon-specific postoperative complication rates after colectomy. Conventional measures of surgeon-specific performance fail to acknowledge variation attributed to statistical noise, risking unreliable assessment of quality. We examined all patients who underwent segmental colectomy with anastomosis from 2008 through 2010 participating in the Michigan Surgical Quality Collaborative Colectomy Project. Surgeon-specific complication rates were risk-adjusted according to patient characteristics with multiple logistic regression. Hierarchical modeling techniques were used to determine the reliability of surgeon-specific risk-adjusted complication rates. We then adjusted these rates for reliability. To evaluate the extent to which surgeon-level variation was reduced, surgeons were placed into quartiles based on performance and complication rates were compared before and after reliability adjustment. A total of 5033 patients (n = 345 surgeons) undergoing partial colectomy reported a risk-adjusted complication rate of 24.5%. Approximately 86% of the variability of complication rates across surgeons was explained by measurement noise, whereas the remaining 14% represented true signal. Risk-adjusted complication rates varied from 0% to 55.1% across quartiles before adjusting for reliability. Reliability adjustment greatly diminished this variation, generating a 1.2-fold difference (21.4%-25.6%). A caseload of 168 colectomies across 3 years was required to achieve a reliability of more than 0.7, which is considered a proficient level. Only 1 surgeon surpassed this volume threshold. The vast majority of surgeons do not perform enough colectomies to generate a reliable surgeon-specific complication rate. Risk-adjusted complication rates should be viewed with caution when evaluating surgeons with low operative volume, as statistical noise is a large determinant in estimating their surgeon-specific complication rates.
    Annals of Surgery 05/2015; 261(5). DOI:10.1097/SLA.0000000000001032 · 8.33 Impact Factor
  • Annals of surgery 04/2015; DOI:10.1097/SLA.0000000000001250 · 7.19 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e723. DOI:10.1016/j.juro.2015.02.2145 · 3.75 Impact Factor
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    ABSTRACT: It is well established that sarcopenic patients are at higher risk of postoperative complications and short-term health care utilization. Less well understood is how these patients fare over the long term after surviving the immediate postoperative period. We explored costs over the first postoperative year among sarcopenic patients. We identified 1279 patients in the Michigan Surgical Quality Collaborative database who underwent inpatient elective surgery at a single institution from 2006-2011. Sarcopenia, defined by gender-stratified tertiles of lean psoas area, was determined from preoperative computed tomography scans using validated analytic morphomics. Data were analyzed to assess sarcopenia's relationship to costs, readmissions, discharge location, intensive care unit admissions, hospital length of stay, and mortality. Multivariate models were adjusted for patient demographics and surgical risk factors. Sarcopenia was independently associated with increased adjusted costs at 30, 90, and 180 but not 365 d. The difference in adjusted postsurgical costs between sarcopenic and nonsarcopenic patients was $16,455 at 30 d and $14,093 at 1 y. Sarcopenic patients were more likely to be discharged somewhere other than home (P < 0.001). Sarcopenia was not an independent predictor of increased readmission rates in the postsurgical year. The effects of sarcopenia on health care costs are concentrated in the immediate postoperative period. It may be appropriate to allocate additional resources to sarcopenic patients in the perioperative setting to reduce the incidence of negative postoperative outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Surgical Research 04/2015; DOI:10.1016/j.jss.2015.04.074 · 2.12 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e699. DOI:10.1016/j.juro.2015.02.2088 · 3.75 Impact Factor
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    ABSTRACT: Abstract Sarcopenia is associated with treatment-related complications and shorter overall survival in patients with cancer. Psoas area indices were calculated for 121 patients with lymphoma who underwent autologous transplant. Controlling for age, body mass index, comorbidities, and performance status for the 73 men included, the hazard ratio (95% confidence interval, CI) for non-relapse mortality was 2.37 (1.01, 5.58), p=0.048 for every 100 unit decrease in total psoas index and 2.67 (1.04, 6.86), p=0.041 for every 100 unit decrease in lean psoas index. Men with a lower total psoas index experienced more complications (p=0.001) and spent more days in the hospital (p=0.03) during the transplant admission. A strong association existed between sarcopenia and number of hospital days in the 100 days following transplant among both men (p<0.0001) and women (p<0.0001). Sarcopenia may impact negative outcomes after autologous transplant thereby serving as a potentially modifiable predictor of outcomes and aiding in treatment selection.
    Leukemia and Lymphoma 03/2015; DOI:10.3109/10428194.2015.1014359 · 2.89 Impact Factor
  • P.K. Henke · G. Zamora-Berridi · M.J. Englesbe
    Journal of Vascular Surgery 03/2015; 61(3):835. DOI:10.1016/j.jvs.2015.01.016 · 2.98 Impact Factor
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    ABSTRACT: Background: Sarcopenia, defined as a decrease in skeletal muscle mass and strength, is an important risk factor in clinical medicine associated with frailty, mortality, and worse surgical and nonsurgical outcomes. Conventional measures of sarcopenia rely on the subjective "eyeball test" and do not adequately describe risk. Computed tomography (CT) imaging studies may be used to objectively measure sarcopenia and may be used for surgical risk stratification and identification of patients for inclusion in a novel clinical remediation program. Methods: We describe results observed in the general, vascular, and liver transplant surgery populations determined by analytic morphomics-an analysis of CT scans in a semiautomated process using MATLAB v13.0. A perioperative optimization program has been implemented with the objective of remediating sarcopenia through improvement of patient mental and physical status prior to surgery. Results: Using analytic morphomics, we have noted significantly higher cost and increased rates of mortality and surgical complications among sarcopenic patients. The training program shows initial success, and among participating patients, we have observed reductions in payer and hospital costs and a decrease in length of hospital stay for patients following surgery. Conclusions: Through analytic morphomics, we are able to quantify markers of sarcopenia and identify patients at risk for increased mortality and poor surgical outcomes. Early identification of patients offers us the opportunity to remediate sarcopenia through perioperative training and support. Participating patients spend less time in the hospital and have lower healthcare costs. This program has the potential to improve the perioperative patient experience and ease financial burdens. © 2015 American Society for Parenteral and Enteral Nutrition.
    Nutrition in Clinical Practice 02/2015; 30(2). DOI:10.1177/0884533615569888 · 2.06 Impact Factor
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    ABSTRACT: In an effort to understand the diminished quality of life (QoL) exhibited by patients with end-stage liver disease (ESLD), we studied the association of frailty and severity of liver disease with quality of life in this patient population. In a prospective, single-center cohort study (N = 487), we assessed frailty and QoL in patients with ESLD referred for liver transplant. Frailty was measured on a scale from 0 to 5 by grip strength, gait speed, exhaustion, shrinkage, and physical activity, with scores of 3 or higher characterized as frail. Physical, mental, and combined overall quality of life scores ranging from 0 to 100 were assessed using Short Form 36. Pearson correlation and multiple linear regression were used to identify variables associated with QoL. Quality of life was notably low in the study cohort (mean: physical, 42.9 ± 24.1; mental, 58.3 ± 23.2). In multivariate analysis adjusted for demographic and clinical characteristics, frailty was significantly negative associated with physical (slope, -22.55, 95% confidence interval, -26.39 to -18.71; P < 0.001) and mental QoL (slope, -17.59, 95% confidence interval, -21.47 to -13.71; P < 0.001). Model for ESLD (MELD) was not associated with QoL. In ESLD patient referred for liver transplant, diminished QoL appears to be significantly negatively associated with frailty and not with severity of liver disease as measured MELD. With further study, if frailty is shown to be a remediable condition, targeted programs may help decrease frailty and improve quality of life in ESLD patients.
    Transplantation 01/2015; DOI:10.1097/TP.0000000000000593 · 3.78 Impact Factor
  • 15th Annual State of the Art Winter Symposium of the; 01/2015
  • 15th Annual State of the Art Winter Symposium of the; 01/2015
  • 15th Annual State of the Art Winter Symposium of the; 01/2015
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    ABSTRACT: Postoperative myocardial infarction (poMI) is a serious and costly complication. Multiple risk factors for poMI are known, but the effect of anemia and cardioprotective medications have not been defined in real-world surgical practice.
    Surgery 10/2014; 156(4):1018-29. DOI:10.1016/j.surg.2014.06.055 · 3.11 Impact Factor
  • Kyle H Sheetz · Michael J Englesbe
    Annals of Surgery 09/2014; 261(1). DOI:10.1097/SLA.0000000000000911 · 8.33 Impact Factor
  • Seth A Waits · Paul Hilliard · Kyle H Sheetz · Randall S Sung · Michael J Englesbe
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    ABSTRACT: Background: Reports from experienced centers suggest that recipients of an ABO-incompatible living-donor kidney transplant after reduction of ABO antibodies experience no penalty in graft and patient survival versus ABO-compatible transplants, but confirmation that these results can be widely replicated is lacking. Methods: Living-donor kidney transplants from ABO-incompatible donors after ABO antibody reduction registered with the Collaborative Transplant Study during 2005 to 2012 were analyzed and compared with (i) a matched group of ABO-compatible transplant recipients and (ii) all ABO-compatible transplants from centers that performed at least five ABO-incompatible grafts during the study period. Results: One thousand four hundred twenty living-donor ABO-incompatible kidney transplants were analyzed. Three-year death-censored graft survival was virtually identical for ABO-incompatible transplants versus matched and center controls (P = 0.92 and P = 0.60, respectively). Patient survival rates were also similar (P = 0.15 and P = 0.11, respectively). Early patient survival was lower in ABO-incompatible grafts (P = 0.006 vs. matched controls; P = 0.001 vs. center controls) because of a higher rate of early infectious death (P = 0.037 and P < 0.001, respectively). Death-censored graft and patient survival were not significantly affected by induction therapy and anti-CD20 treatment. ABO antibody reduction by column adsorption was associated with similar death-censored graft survival to plasmapheresis. Conclusion: In this analysis of prospectively collected data from a large series of ABO-incompatible living-donor kidney transplants performed at 101 centers, death-censored graft and patient survival rates were similar to those achieved in ABO-compatible control groups over the same period.
    Transplantation 09/2014; 99(2). DOI:10.1097/TP.0000000000000328 · 3.78 Impact Factor
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    ABSTRACT: Introduction Perioperative mortality in the elderly is high following emergency surgery and varies significantly between hospitals an observation partially explained by differences in failure to rescue. We hypothesize that failure to rescue following certain types of complications underlies the disproportionately poor outcomes observed in elderly patients. Methods We identified 23,217 patients undergoing emergent general or vascular surgery procedures at 41 hospitals within the Michigan Surgical Quality Collaborative between 2007 and 2012. Patients’ first complications were identified and categorized by type. We compared failure to rescue rates at the patient-level between patients <75 and ≥75 years of age. We then compared failure to rescue rates after specific complications across hospitals grouped in tertiles by risk-adjusted 30-day mortality. Results Risk-adjusted failure to rescue rates were significantly higher in the elderly after a first infectious (21.7% vs. 10.3%; p<0.01) or pulmonary (38.2% vs. 20.4%; p<0.01) complication when compared to younger patients. At the hospital level, high morality centers failed to rescue elderly patients more frequently than low mortality centers after a first infectious (35.6% v. 22.2%; p<0.01) and pulmonary (24.3 v. 14.3; p<0.01) complication. Failure to rescue rates following cardiovascular complications did not differ significantly across patient ages or tertiles of hospital mortality. Conclusion Hospitals fail to rescue elderly patients at higher rates than younger patients after infectious and pulmonary complications. Efforts to recognize and manage these specific complications have the potential to improve emergency surgical care of the elderly in Michigan.
    Journal of the American College of Surgeons 09/2014; 219(3). DOI:10.1016/j.jamcollsurg.2014.02.035 · 4.45 Impact Factor
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    ABSTRACT: IntroductionBetter measures of liver transplant risk stratification are needed. Our previous work noted a strong relationship between psoas muscle area and survival following liver transplantation. The dorsal muscle group is easier to measure but it is unclear if they are also correlated with surgical outcomes.Methods Our study population included liver transplant recipients with a preoperative CT scan. Cross-sectional areas of the dorsal muscle group at the T12 vertebral level were measured. The primary outcomes for this study were 1 and 5-year mortality and 1-year complications. The relationship between dorsal muscle group area and post-transplantation outcome was assessed using univariate and multivariate techniques.ResultsDorsal muscle group area measurements were strongly associated with psoas area (r = 0.72; p < 0.001). Postoperative outcome was observed from 325 patients. Multivariate logistic regression revealed dorsal muscle group area to be a significant predictor of 1-year mortality (odds ratio [OR] = 0.53, p = 0.001,) and 5-year mortality (OR = 0.53, p < 0.001), and 1-year complications (OR = 0.67, p = 0.007).Conclusion Larger dorsal muscle group muscle size is associated with improved post-transplantation outcomes. The muscle is easier to measure and may represent a clinically relevant postoperative risk factor.This article is protected by copyright. All rights reserved.
    Clinical Transplantation 07/2014; 28(10). DOI:10.1111/ctr.12422 · 1.49 Impact Factor
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    ABSTRACT: Background: Older patients account for nearly half of the United States surgical volume, and age alone is insufficient to predict surgical fitness. Various metrics exist for risk stratification, but little work has been done to describe the association between measures. We aimed to determine whether analytic morphomics, a novel objective risk assessment tool, correlates with functional measures currently recommended in the preoperative evaluation of older patients. Materials and methods: We retrospectively identified 184 elective general surgery patients aged >70 y with both a preoperative computed tomography scan and Vulnerable Elderly Surgical Pathways and outcomes Assessment within 90 d of surgery. We used analytic morphomics to calculate trunk muscle size (or total psoas area [TPA]) and univariate logistic regression to assess the relationship between TPA and domains of geriatric function mobility, basic and instrumental activities of daily living (ADLs), and cognitive ability. Results: Greater TPA was inversely correlated with impaired mobility (odds ratio [OR] = 0.46, 95% confidence interval [CI] 0.25-0.85, P = 0.013). Greater TPA was associated with decreased odds of deficit in any basic ADLs(OR = 0.36 per standard deviation unit increase in TPA, 95% CI 0.15-0.87, P<0.03) and any instrumental ADLs (OR = 0.53, 95% CI 0.34-0.81; P<0.005). Finally, patients with larger TPA were less likely to have cognitive difficulty assessed by Mini-Cog scale (OR = 0.55, 95% CI 0.35-0.86, P<0.01). Controlling for age did not change results. Conclusions: Older surgical candidates with greater trunk muscle size, or greater TPA, are less likely to have physical impairment, cognitive difficulty, or decreased ability to perform daily self-care. Further research linking these assessments to clinical outcomes is needed.
    Journal of Surgical Research 06/2014; 192(1). DOI:10.1016/j.jss.2014.06.011 · 2.12 Impact Factor
  • Michael J. Englesbe · Amit K. Mathur · Seth A. Waits · John C. Magee
    Liver Transplantation 06/2014; 20(6). DOI:10.1002/lt.23865 · 3.79 Impact Factor

Publication Stats

2k Citations
676.40 Total Impact Points

Institutions

  • 2005–2015
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2005–2014
    • University of Michigan
      • Department of Surgery
      Ann Arbor, Michigan, United States
  • 2004
    • University Center Rochester
      Рочестер, Minnesota, United States
    • University of Washington Seattle
      • Department of Surgery
      Seattle, Washington, United States