Michael J Englesbe

University of Michigan, Ann Arbor, Michigan, United States

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Publications (195)739.42 Total impact

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    ABSTRACT: Objective: The aim of the study was to characterize patient-reported outcomes of analgesia practices in a population-based surgical collaborative. Background: Pain control among hospitalized patients is a national priority and effective multimodal pain management is an essential component of postoperative recovery, but there is little understanding of the degree of variation in analgesia practice and patient-reported pain between hospitals. Methods: We evaluated patient-reported pain scores after colorectal operations in 52 hospitals in a state-wide collaborative. We stratified hospitals by quartiles of average pain scores, identified hospital characteristics, pain management practices, and clinical outcomes associated with highest and lowest case-mix-adjusted pain scores, and compared against Hospital Consumer Assessment of Healthcare Providers and Systems pain management metrics. Results: Hospitals with the lowest pain scores were larger (503 vs 452 beds; P < 0.001), higher volume (196 vs 112; P = 0.005), and performed more laparoscopy (37.7% vs 27.2%; P < 0.001) than those with highest scores. Their patients were more likely to receive local anesthesia (31.1% vs 12.9%; P < 0.001), nonsteroidal anti-inflammatory drugs (33.5% vs 14.4%; P < 0.001), and patient-controlled analgesia (56.5% vs 22.8%; P < 0.001). Adverse postoperative outcomes were less common in hospitals with lowest pain scores, including complications (20.3% vs 26.4%; P < 0.001), emergency department visits (8.2% vs 15.8%; P < 0.001), and readmissions (11.3% vs 16.2%; P = 0.01). Conclusions: Pain management after colorectal surgery varies widely and predicts significant differences in patient-reported pain and clinical outcomes. Enhanced postoperative pain management requires dissemination of multimodal analgesia practices. Attention to patient-reported outcomes often omitted from surgical outcomes registries is essential to improving quality from the patient's perspective.
    No preview · Article · Jan 2016 · Annals of surgery

  • No preview · Article · Jan 2016 · American Journal of Transplantation

  • No preview · Article · Jan 2016 · American Journal of Transplantation
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    ABSTRACT: Background: Current measures of obesity do not accurately describe body composition. Using cross-sectional imaging, objective measures of musculature and adiposity are possible and may inform efforts to optimize liver transplantation outcomes. Methods: Abdominal visceral fat area and psoas muscle cross-sectional area were measured on CT scans for 348 liver transplant recipients. After controlling for donor and recipient characteristics, survival analysis was performed using Cox regression. Results: Visceral fat area was significantly associated with post-transplant mortality (p<0.001; HR=1.06 per 10 cm(2) , 95%CI: 1.04 - 1.09), as were positive hepatitis C status (p=0.004; HR = 1.78, 95%CI: 1.21 - 2.61) and total psoas area (p<0.001; HR = 0.91 per cm(2) , 95%CI: 0.88 - 0.94). Among patients with smaller total psoas area, the patients with high visceral fat area had 71.8% 1-year survival compared to 81.8% for those with low visceral fat area (p=0.15). At 5 years, the smaller muscle patients with high visceral fat area had 36.9% survival compared to 58.2% for those with low visceral fat area (p=0.023). Conclusions: Abdominal adiposity is associated with survival after liver transplantation, especially in patients with small trunk muscle size. When coupled with trunk musculature, abdominal adiposity offers direct characterization of body composition that can aid preoperative risk evaluation and inform transplant decision-making. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2015 · Clinical Transplantation

  • No preview · Article · Nov 2015
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    ABSTRACT: An objective frailty assessment tool for patients with aortic stenosis is critical in determining optimal treatment choice, either open (SAVR) or catheter based (TAVR) therapy. This study evaluates sarcopenia as a frailty tool for patients undergoing either SAVR or TAVR.
    No preview · Article · Nov 2015
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    Full-text · Article · Nov 2015
  • Aaron M. Williams · Seth Waits · Michael J. Englesbe
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    ABSTRACT: Over 15,000 patients are listed for liver transplantation across the USA while only 6500 transplants are performed each year. Given the realities of this profound organ shortage, optimal patient preparation is important to assure good outcomes. In recent years, frailty and sarcopenia have emerged as important predictors of post-transplant mortality. Potentially, these risk factors may be remediable with preoperative preparation. Efforts to improve disease management and physical conditioning could not only optimize patients for liver transplantation but could also improve outcomes among those who do not undergo transplantation.
    No preview · Article · Oct 2015
  • 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.
    No preview · Article · Sep 2015 · Journal of Surgical Education
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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.
    No preview · Article · Sep 2015 · Journal of Surgical Education
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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.
    No preview · Article · Sep 2015 · Urology
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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.
    No preview · Article · Sep 2015 · Clinical Transplantation
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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.
    No preview · Article · Jun 2015 · Journal of Surgical Research
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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.
    No preview · Article · May 2015 · Annals of Surgery
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    ABSTRACT: Our surgical home program in Michigan has focused narrowly on surgical decision making and preoperative optimization. We aspire to expand the breadth of the program to affect a patient's entire surgical journey once we stably implement across the state of Michigan. Novel technologies at the bedside have improved surgical decision making by clinicians and patients and are key to continued success. We believe all patients should be given the opportunity to train for surgery. Even if this does not have a relevant physiologic effect, it will empower patients and engage them in their perioperative care. The challenge now is dissemination and implementation.
    No preview · Article · Apr 2015 · Annals of surgery
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    Preview · Article · Apr 2015 · The Journal of Urology

  • No preview · Article · Apr 2015 · The Journal of Urology
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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.
    No preview · Article · Apr 2015 · Journal of Surgical Research
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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.
    No preview · Article · Mar 2015 · Leukemia and Lymphoma
  • P.K. Henke · G. Zamora-Berridi · M.J. Englesbe

    No preview · Article · Mar 2015 · Journal of Vascular Surgery

Publication Stats

3k Citations
739.42 Total Impact Points

Institutions

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