Michael J Englesbe

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

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Publications (182)699.14 Total impact

  • Aaron M. Williams · Seth Waits · Michael J. Englesbe ·

    10/2015; DOI:10.1007/s40472-015-0080-7
  • Bradley N Reames · Kyle H Sheetz · Michael J Englesbe · Seth A Waits ·
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    ABSTRACT: Objective: Although it has been suggested that social-networking services such as Twitter could be used as a tool for medical education, few studies have evaluated its use in this setting. We sought to evaluate the use of Twitter as a novel educational tool in a medical school surgery clerkship. We hypothesized that Twitter can enhance the educational experience of clerkship students. Design: We performed a prospective observational study. We created a new Twitter account, and delivered approximately 3 tweets per day consisting of succinct, objective surgical facts. Students were administered pre- and postclerkship surveys, and aggregate test scores were obtained for participating students and historical controls. Setting: Required third-year medical school surgery clerkship at the University of Michigan large tertiary-care academic hospital. Participants: Third-year medical students. Results: The survey response rate was 94%. Preclerkship surveys revealed that most (87%) students have smartphones, and are familiar with Twitter (80% have used before). Following completion of the clerkship, most students (73%) reported using the Twitter tool, and 20% used it frequently. Overall, 59% believed it positively influenced their educational experience and very few believed it had a negative influence (2%). However, many (53%) did not believe it influenced their clerkship engagement. Aggregate mean National Board of Medical Examiners Shelf Examination scores were not significantly different in an analysis of medical student classes completing the clerkship before or after the Twitter tool (p = 0.37). Conclusions: Most of today's learners are familiar with social media, and own the technology necessary to implement novel educational tools in this platform. Applications such as Twitter can be facile educational tools to supplement and enhance the experience of students on a medical school clerkship.
    Journal of Surgical Education 09/2015; DOI:10.1016/j.jsurg.2015.08.005 · 1.38 Impact Factor
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    ABSTRACT: Objective: The development of operative skills during general surgery residency depends largely on the resident surgeons' (residents) ability to accurately self-assess and identify areas for improvement. We compared evaluations of laparoscopic skills and comfort level of residents from both the residents' and attending surgeons' (attendings') perspectives. Design: We prospectively observed 111 elective cholecystectomies at the University of Michigan as part of a larger quality improvement initiative. Immediately after the operation, both residents and attendings completed a survey in which they rated the residents' operative proficiency, comfort level, and the difficulty of the case using a previously validated instrument. Residents' and attendings' evaluations of residents' performance were compared using 2-sided t tests. Setting: The University of Michigan Health System in Ann Arbor, MI. Large academic, tertiary care institution. Participants: All general surgery residents and faculty at the University of Michigan performing laparoscopic cholecystectomy between June 1 and August 31, 2013. Data were collected for 28 of the institution's 54 trainees. Results: Attendings rated residents higher than what residents rated themselves on a 5-point Likert-type scale regarding depth perception (3.86 vs. 3.38, p < 0.005), bimanual dexterity (3.75 vs. 3.36, p = 0.005), efficiency (3.58 vs. 3.18, p < 0.005), tissue handling (3.69 vs. 3.23, p < 0.005), and comfort while performing a case (3.86 vs. 3.38, p < 0.005). Attendings and residents were in agreement on the level of autonomy displayed by the resident during the case (3.31 vs. 3.34, p = 0.85), the level of difficulty of the case (2.98 vs. 2.85, p = 0.443), and the degree of teaching done by the attending during the case (3.61 vs. 3.54, p = 0.701). Conclusions: A gap exists between residents' and attendings' perception of residents' laparoscopic skills and comfort level in performing laparoscopic cholecystectomy. These findings call for improved communication between residents and attendings to ensure that graduates are adequately prepared to operate independently. In the context of changing methods of resident evaluations that call for explicitly defined competencies in surgery, it is essential that residents are able to accurately self-assess and be in general agreement with attendings on their level of laparoscopic skills and comfort level while performing a case.
    Journal of Surgical Education 09/2015; DOI:10.1016/j.jsurg.2015.07.002 · 1.38 Impact Factor
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    ABSTRACT: Objectives: To examine the magnitude and sources of inpatient cost variation for kidney transplantation. Methods: We used the 2005-2009 Nationwide Inpatient Sample to identify patients who underwent kidney transplantation. We first calculated the patient level cost of each transplantation admission and then aggregated costs to the hospital level. We fit hierarchical linear regression models to identify sources of cost variation and to estimate how much unexplained variation remained after adjusting for case-mix variables commonly found in administrative datasets. Results: We identified 8,866 living donor (LDRT) and 5,589 deceased donor (DDRT) kidney transplantations. We found that higher costs were associated with the presence of complications (LDRT 14%, p<0.001; DDRT 24%, p<0.001), plasmapheresis (LDRT 27%, p<0.001; DDRT 27%, p<0.001), dialysis (LDRT 4%, p<0.001) and prolonged length of stay (LDRT 84%%, p<0.001; DDRT 82%, p<0.001). Even after case-mix adjustment, a considerable amount of unexplained cost variation remained between transplant centers (DDRT 52%, LDRT 66%). Conclusions: While significant inpatient cost variation is present across transplant centers, much of the cost variation for kidney transplantation is not explained by commonly used risk-adjustment variables in administrative datasets. These findings suggest that while there is an opportunity to achieve savings through payment reforms for kidney transplantation, policymakers should seek alternative sources of information (e.g., clinical registry data) to delineate sources of warranted and unwarranted cost variation.
    Urology 09/2015; DOI:10.1016/j.urology.2015.05.037 · 2.19 Impact Factor
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    ABSTRACT: Introduction: Sarcopenic liver transplant recipients have higher rates of mortality, but mechanisms underlying these rates remain unclear. Failure to rescue (FTR) has been shown to be a primary driver of mortality following major general and vascular surgery. We hypothesized that FTR is common in sarcopenic liver transplant recipients. Methods: We retrospectively reviewed 348 liver transplant recipients with perioperative CT scans. Analytic morphomic techniques were used to assess trunk muscle size via total psoas area (TPA). One-year major complication and FTR rates were calculated across TPA tertiles. Results: The one-year complication rate was 77% and the FTR rate was 19%. Multivariate regression showed TPA as a significant predictor of FTR (OR=0.27 per 1000mm(2) increase in TPA, P<0.001). Compared to patients in the largest muscle tertile, patients in the smallest tertile had 1.4-fold higher adjusted complication rates (91% vs 66%) and 2.8-fold higher adjusted FTR rates (22% vs 8%). Discussion: These results suggest that mortality in sarcopenic liver transplant recipients may be strongly related to FTR. Efforts aimed at early recognition and management of complications may decrease postoperative mortality. Additionally, this work highlights the need for expanded multicenter collaborations aimed at collection and analysis of postoperative complications in liver transplant recipients. This article is protected by copyright. All rights reserved.
    Clinical Transplantation 09/2015; DOI:10.1111/ctr.12629 · 1.52 Impact Factor
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    ABSTRACT: Background: 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. Materials and methods: Review of end of clerkship third year of medical school trauma burn surgery rotation evaluations and comments was performed for the 2010-2011 academic year. Trends in negative feedback were identified and categorized into five areas for improvement as follows: logistics, student expectations, communication, team integration, and feedback. A plan was designed and implemented for each category. Feedback on improvements to the rotation was monitored via surveys and during monthly end of rotation face-to-face student feedback sessions with the rotation faculty facilitator and surgery clerkship director. Data were compiled and reviewed. Results: Perceptions of the rotation markedly improved within the first month of the changes and continued to improve over the study time frame (2011-2013) in all five categories. We also observed an increase in the number of students selecting a surgical residency in the National Resident Matching Program match from a low of 8% in 2009-2010 before any interventions to 25% after full implementation of the improvement measures in 2011-2012. Conclusions: A systematic approach using direct feedback from students to address service-specific issues improves perceptions of students on the educational value of a busy trauma-burn acute care surgery service and may have a positive influence on students considering surgical careers to pursue a surgical specialty.
    Journal of Surgical Research 06/2015; DOI:10.1016/j.jss.2015.05.062 · 1.94 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 · 8.33 Impact Factor

  • The Journal of Urology 04/2015; 193(4):e699. DOI:10.1016/j.juro.2015.02.2088 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e723. DOI:10.1016/j.juro.2015.02.2145 · 4.47 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; 199(1). DOI:10.1016/j.jss.2015.04.074 · 1.94 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; 56(10):1-30. 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 · 3.02 Impact Factor
  • Jeffrey Friedman · Alisha Lussiez · June Sullivan · Stewart Wang · Michael Englesbe ·
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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 · 2.40 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; 99(2). DOI:10.1097/TP.0000000000000593 · 3.83 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: Objective: 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. Methods: Patients undergoing inpatient elective surgery were assessed at 17 hospitals from 2008 to 2011 for the occurrence of poMI (American Heart Association definition). Non-MI control patients were chosen randomly on the basis of case type. Descriptive, univariable, and multivariable statistical analysis were performed for primary outcomes of poMI and death at 30 days. Results: Compared with controls (N = 304), patients with poMI (N = 222) were older (72 ± 11 vs 60 ± 17 years, P < .0001), had a lesser preoperative hematocrit (37 ± 6 vs 39 ± 5, P < .0001), more often were smokers, had a preoperative T-wave abnormality (21% vs 9%, P < .0001), and had a preoperative stress test with a fixed deficit (26% vs 3%; P < .001). Preoperative factors associated with poMI included peripheral vascular disease (odds ratio 2.6; 95% confidence interval 1.3-5.3), tobacco use (1.7; 1.01-2.9), history of percutaneous coronary angioplasty (2.8; 1.6-5.0), and age (1.05; 1.03-1.07), whereas hematocrit >35 (0.51; 0.32-0.82) and preoperative acetylsalicylic acid, ie, aspirin (0.59; 0.4-0.97) were protective. Preoperative β-blockade, statin, and use of angiotensin-converting enzyme inhibitors were not associated with lesser rates of poMI. Non-MI complication rates were 23-fold greater in the poMI group compared with the control group (P < .0001). Mortality with poMI within 30 days was 11% compared with 0.3% in non-MI control patients (P < .0001). In patients with poMI, factors independently associated with death included use of epidurals (3.5; 1.07-11.4) and bleeding (4.2; 1.1-16), whereas preoperative use of aspirin (0.29; 0.1-0.88), and postoperative β-blockade (0.18; 0.05-0.63) were protective. Cardiac catheterization, percutaneous coronary intervention, or coronary artery bypass grafting after poMI was performed in 34% of those alive and 20% of those who died (P = .16). Conclusion: In the current era, poMI patients have a markedly increased risk of death. This risk is decreased with preoperative use of acetylsalicylic acid and post MI β-blockade. Further study is warranted to explore the role of anemia and cardiac interventions after poMI.
    Surgery 10/2014; 156(4):1018-29. DOI:10.1016/j.surg.2014.06.055 · 3.38 Impact Factor

Publication Stats

3k Citations
699.14 Total Impact Points


  • 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