Biography
Finlayson's research examines population-based surgical outcomes, focusing particularly on functional outcomes in the frail elderly.
Finlayson earned her medical degree at Harvard Medical School. She trained in general surgery at UCSF and in colon and rectal surgery at the Mayo Clinic in Rochester, Minnesota. She also earned a master of science degree at the Dartmouth Institute for Health Policy and Clinical Practice, and she completed a research fellowship with the White River Junction Veterans Affairs Medical Center in Vermont.
Finlayson served on the surgery department faculty at the University of Michigan and on the Michigan Surgical Collaborative for Outcomes Research and Evaluation. She returned to UCSF in 2009.
Education
Institution | Degree | Dept or School | End Date |
---|---|---|---|
University of California | Diversity, Equity, and Inclusion Champion Training | 2019 | |
Harvard University | M.D. | School of Medicine | 1997 |
Board Certifications
- American Board of Surgery, 2005
- American Board of Colon and Rectal Surgery, 2006
Clinical Expertise
Anal Cancer
Colitis
Colon Cancer
Constipation
Crohn's Disease
Diverticulitis
Fecal Incontinence
Hemorrhoids
Inflammatory Bowel Disease
Pelvic Floor Disorders
Presacral Tumors
Rectal Cancer
Ulcerative Colitis
Clinical Trials
- Related Conditions: Colon Cancer, Colorectal Cancer, Colorectal Tumor| Start Date: | End Date:
- Related Conditions: Communication| Start Date: | End Date:
Program Affiliations
- Philip R. Lee Institute for Health Policy Studies, UCSF
- UCSF Center for Surgery in Older Adults (CSOA)
In the News
Grants and Funding
- Developing Tools to Support the Appropriate Use of Surgery in Frail Older Adults | NIH | 2017-09-01 - 2020-05-31 | Role: Principal Investigator
- Optimizing treatment for nursing home residents with acute cholecystitis | NIH | 2014-04-15 - 2020-03-31 | Role: Principal Investigator
- Functional Outcomes After Major Surgery in Nursing Home Residents | NIH | 2006-09-01 - 2012-08-31 | Role: Principal Investigator
Research Narrative
Dr. Finlayson’s research focuses on using administrative data to examine ‘real world’ surgical outcomes in the elderly. For example, in an analysis of operative mortality in 1.2 million Medicare beneficiaries age 65 and older undergoing elective diagnostic high-risk surgery, she found that the risk of death increased dramatically with age. Her work examining the impact of age and comorbidity on operative mortality and survival among octogenarians undergoing cancer surgery demonstrated population-based mortality rates in octogenarians that were considerably higher than those reported in published reports from case series or trials. To better understand surgical risks in elders, she has explored the role of institutional factors in surgical outcomes. As is now widely recognized, her work demonstrated that provider procedure volume is inversely related to operative mortality for many high-risk operations and that this association was greatest in elder surgical patients.
In Dr. Finlayson’s most recent work, she uses a national nursing home registry to evaluate outcomes after surgery in long stay nursing home residents. She found that nursing home residents experienced high operative mortality for ‘low risk’ procedures. After operations to remove the gallbladder or appendix, more that 1 out of 10 nursing home residents died after surgery. She has also used this data to evaluate survival and functional status after colon cancer surgery and found that nursing home residents experience substantial and sustained functional decline after surgery. One-year survival was less than 50%.
The findings in her epidemiology research inspired the creation of the UCSF Center for Surgery in Older Adults. Under her leadership, the interdisciplinary team of stakeholders from surgery, anesthesia, rehabilitation services, geriatrics, palliative care, nursing, education, and health policy with expertise in quantitative research, qualitative research, and implementation science are working together to develop, implement, evaluate best practices in geriatric surgery through the development of a geriatric surgery registry. Our overarching goal is to discover best practices in geriatric surgery through patient-centered outcomes assessment, comparative effectiveness analyses, and interventional trials. In addition, we identify and explore barriers to delivery of optimal care with the aim to improve implementation of interdisciplinary patient-centered surgical care for older adults at UCSF and beyond.
Research Interests
Surgical outcomes in frail elderly patients
Publications
- Improving Surgical Care and Outcomes in Older Cancer Patients Through Implementation of a Pre-Surgical Toolkit (OPTI-Surg)-Final Results of a Phase III Cluster Randomized Trial (Alliance A231601CD).| | View in PubMed
- Associations of Resilience, Perceived Control of Health, and Depression with Geriatric Outcomes after Surgery.| | View in PubMed
- Use of Muscle Relaxants After Surgery in Traditional Medicare Part D Enrollees.| | View in PubMed
- Clinician Perspectives on How Family Support and Psychological Distress Influence Older Adults' Recovery After Major Surgery.| | View in PubMed
- Association of Race and Ethnicity With Postoperative Gabapentinoid and Opioid Prescribing Trends for Older Adults.| | View in PubMed
- "It Gives Me Peace of Mind So I Can Focus on Healing": Views on Advance Care Planning for Older Surgical Patients.| | View in PubMed
- Risk factors and associated outcomes of postoperative delirium after open abdominal aortic aneurysm repair.| | View in PubMed
- Social Strain is associated with Functional Decline in Older Adults after Surgery.| | View in PubMed
- Reimagining Ambulatory Care in Urology: Conversion of the Urology Clinic into a Procedure Center Improves Patient's Experience.| | View in PubMed
- Clinician Review of Advanced Care Planning for Older Surgical Patients Requiring Intensive Care.| | View in PubMed
- Trends in the Use of Gabapentinoids and Opioids in the Postoperative Period Among Older Adults.| | View in PubMed
- Experiences with targeting inpatient advance care planning for emergency general surgery patients: A resident-led quality improvement project.| | View in PubMed
- Multisite Implementation of an American College of Surgeons Geriatric Surgery Quality Improvement Initiative.| | View in PubMed
- Cognitive Impairment is Common in a Veterans Affairs Population with Peripheral Arterial Disease.| | View in PubMed
- Missed Opportunities and Health Disparities for Advance Care Planning Before Elective Surgery in Older Adults.| | View in PubMed
- High risk of complications after a "low risk" procedure: A national study of nursing home residents and older adults undergoing haemorrhoid surgery.| | View in PubMed
- Prolonged use of newly prescribed gabapentin after surgery.| | View in PubMed
- "I Wish Someone had Asked Me Earlier"-Perspectives on Advance Care Planning in Surgery.| | View in PubMed
- Characteristics and Procedures Among Adults Discharged to Hospice After Gastrointestinal Tract Surgery in California.| | View in PubMed
- Functional and cognitive outcomes after suprapubic catheter placement in nursing home residents: A national cohort study.| | View in PubMed
- Patients living with dementia have worse outcomes when undergoing high-risk procedures.| | View in PubMed
- Reply by Authors.| | View in PubMed
- Frailty Is Associated with an Increased Risk of Complications and Need for Repeat Procedures after Sling Surgery in Older Adults.| | View in PubMed
- Ileostomy or ileal pouch-anal anastomosis for ulcerative colitis: patient participation and decisional needs.| | View in PubMed
- Frequency of Preoperative Advance Care Planning for Older Adults Undergoing High-risk Surgery: A Secondary Analysis of a Randomized Clinical Trial.| | View in PubMed
- Expressions of conflict following postoperative complications in older adults having major surgery.| | View in PubMed
- Comparative Outcomes for Pelvic Organ Prolapse Surgery among Nursing Home Residents and Matched Community Dwelling Older Adults. Reply.| | View in PubMed
- Comparative outcomes for older adults undergoing surgery for bladder and bowel dysfunction.| | View in PubMed
- Patient Factors Associated With Parathyroidectomy in Older Adults With Primary Hyperparathyroidism.| | View in PubMed
- An Implementation-Effectiveness Study of a Perioperative Delirium Prevention Initiative for Older Adults.| | View in PubMed
- Derivation, Validation, Sustained Performance, and Clinical Impact of an Electronic Medical Record-Based Perioperative Delirium Risk Stratification Tool.| | View in PubMed
- Reply by Authors.| | View in PubMed
- The American College of Surgeons Geriatric Surgery Verification Program and the Practicing Colorectal Surgeon.| | View in PubMed
- Preoperative Depressive Symptoms Associated with Poor Functional Recovery after Surgery.| | View in PubMed
- Comparative Outcomes for Pelvic Organ Prolapse Surgery among Nursing Home Residents and Matched Community Dwelling Older Adults.| | View in PubMed
- Living in a Food Desert is Associated with 30-day Readmission after Revascularization for Chronic Limb-Threatening Ischemia.| | View in PubMed
- Association of Functional, Cognitive, and Psychological Measures With 1-Year Mortality in Patients Undergoing Major Surgery.| | View in PubMed
- Patient complexity by surgical specialty does not correlate with work relative value units.| | View in PubMed
- Time Spent Away from Home in the Year Following High-Risk Cancer Surgery in Older Adults.| | View in PubMed
- Long-Term Trends in Postoperative Opioid Prescribing, 1994 to 2014.| | View in PubMed
- Effectiveness of a Question Prompt List Intervention for Older Patients Considering Major Surgery: A Multisite Randomized Clinical Trial.| | View in PubMed
- Including the Family in Perioperative Care of Older Adults-A Call for HELP.| | View in PubMed
- Is there a role for specialized geriatric centers in treating geriatric cancer patients?| | View in PubMed
- What Matters? The Valued Life Activities of Older Adults Undergoing Elective Surgery.| | View in PubMed
- The impact of frailty on treatment for overactive bladder in older adults.| | View in PubMed
- How Did We Get Here? A Broader View of the Postoperative Period.| | View in PubMed
- Invasive Procedures to Improve Function in Frail Older Adults: Do Outcomes Justify the Intervention?| | View in PubMed
- The Association Between Race and Frailty in Older Adults Presenting to a Nononcologic Urology Practice.| | View in PubMed
- Optimizing the Feasibility and Scalability of a Geriatric Surgery Quality Improvement Initiative.| | View in PubMed
- Functional Status and Survival After Breast Cancer Surgery in Nursing Home Residents.| | View in PubMed
- Depth of Propofol Sedation and Postoperative Delirium: The Jury Is Still Out.| | View in PubMed
- Increasing Advance Care Planning Using a Surgical Optimization Program for Older Adults.| | View in PubMed
- Patient Frailty Should Be Used to Individualize Treatment Decisions in Primary Hyperparathyroidism.| | View in PubMed
- Postoperative Delirium as a Target for Surgical Quality Improvement.| | View in PubMed
- Mortality and Functional Outcomes After Minor Urological Surgery in Nursing Home Residents: A National Study.| | View in PubMed
- Application of the RAND-UCLA Appropriateness Methodology to a Large Multidisciplinary Stakeholder Group Evaluating the Validity and Feasibility of Patient-Centered Standards in Geriatric Surgery.| | View in PubMed
- Association of Patient Frailty With Increased Morbidity After Common Ambulatory General Surgery Operations.| | View in PubMed
- Hospital Standards to Promote Optimal Surgical Care of the Older Adult: A Report From the Coalition for Quality in Geriatric Surgery.| | View in PubMed
- The American Society of Colon and Rectal Surgeons Clinical Practice Guideline for the Prevention of Venous Thromboembolic Disease in Colorectal Surgery.| | View in PubMed
- Treatment Intensity After Traumatic Brain Injury: More Is Not Better.| | View in PubMed
- Estimating Risk of Postsurgical General and Geriatric Complications Using the VESPA Preoperative Tool.| | View in PubMed
- Optimizing Surgical Quality Datasets to Care for Older Adults: Lessons from the American College of Surgeons NSQIP Geriatric Surgery Pilot.| | View in PubMed
- Frailty-Going From Measurement to Action.| | View in PubMed
- Author Reply.| | View in PubMed
- Navigating high-risk surgery: protocol for a multisite, stepped wedge, cluster-randomised trial of a question prompt list intervention to empower older adults to ask questions that inform treatment decisions.| | View in PubMed
- Overactive Bladder Is Strongly Associated With Frailty in Older Individuals.| | View in PubMed
- The Timed Up and Go Test as a Measure of Frailty in Urologic Practice.| | View in PubMed
- Delivery Mode in Pregnant Patients with IBD: Uncertainty Remains.| | View in PubMed
- Impact of Multimodality Pain Regimens on Elective Colorectal Surgery Outcomes.| | View in PubMed
- A Call for Frailty Screening in the Preoperative Setting.| | View in PubMed
- Frailty and the Role of Obliterative versus Reconstructive Surgery for Pelvic Organ Prolapse: A National Study.| | View in PubMed
- Functional Outcomes After Transurethral Resection of the Prostate in Nursing Home Residents.| | View in PubMed
- Early learners as health coaches for older adults preparing for surgery.| | View in PubMed
- Changing Paradigms in Detection of Dysplasia and Management of Patients With Inflammatory Bowel Disease: Is Colectomy Still Necessary?| | View in PubMed
- Development of a Nonparametric Predictive Model for Readmission Risk in Elderly Adults After Colon and Rectal Cancer Surgery.| | View in PubMed
- Focus on Surgical Outcomes That Matter to Older Patients.| | View in PubMed
- Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study.| | View in PubMed
- Author Reply.| | View in PubMed
- Thinking Beyond Age for Postacute Care After Major Abdominal Surgery: A New Surgical Era.| | View in PubMed
- Preoperative Frailty Is Associated With Discharge to Skilled or Assisted Living Facilities After Urologic Procedures of Varying Complexity.| | View in PubMed
- A Novel Decision Aid for Surgical Patients with Ulcerative Colitis: Results of a Pilot Study.| | View in PubMed
- Postoperative Functional Outcomes in Older Adults.| | View in PubMed
- Surgical oncology outcomes in the aging US population.| | View in PubMed
- Center the Patient in the Decision Process: A Tool to Inform the Consent and Share the Decision-Making in Patients With Rectal Cancer.| | View in PubMed
- Impact of frailty on complications in patients undergoing common urological procedures: a study from the American College of Surgeons National Surgical Quality Improvement database.| | View in PubMed
- Impact of Surgery on Relationship Quality in Patients With Ulcerative Colitis and Their Partners.| | View in PubMed
- Association of Reference Payment for Colonoscopy With Consumer Choices, Insurer Spending, and Procedural Complications.| | View in PubMed
- Impact of Patient Age on Procedure Type for Ulcerative Colitis: A National Study.| | View in PubMed
- Outcomes Analysis of Biologic Mesh Use for Abdominal Wall Reconstruction in Clean-Contaminated and Contaminated Ventral Hernia Repair.| | View in PubMed
- Functional outcomes after lower extremity revascularization in nursing home residents: a national cohort study.| | View in PubMed
- Outcomes after ileoanal pouch surgery in frail and older adults.| | View in PubMed
- Reply to N.H. Turner et al and Ł. Dziki et al.| | View in PubMed
- Perineal flap reconstruction following oncologic anorectal extirpation: an outcomes assessment.| | View in PubMed
- The significance of preoperative impaired sensorium on surgical outcomes in nonemergent general surgical operations.| | View in PubMed
- RAMPing up the quality of rectal cancer surgery.| | View in PubMed
- How to best forecast adverse outcomes following geriatric trauma: an ageless question?| | View in PubMed
- Preoperative assessment of the older patient: a narrative review.| | View in PubMed
- Advancing age and 30-day adverse outcomes after nonemergent general surgeries.| | View in PubMed
- Elective surgery in dialysis patients: realistic risk information from the American College of Surgeons National Surgical Quality Improvement Program Database: comment on “risk of major nonemergent inpatient general surgical procedures in patients on lo| | View in PubMed
- Outcomes after rectal cancer surgery in elderly nursing home residents.| | View in PubMed
- Elective Surgery in Dialysis Patients: Comment on "Risk of Major Nonemergent Inpatient General Surgical Procedures in Patients on Long-term Dialysis"| | View in PubMed
- Functional status after colon cancer surgery in elderly nursing home residents.| | View in PubMed
- Major abdominal surgery in nursing home residents: a national study.| | View in PubMed
- Inappropriate medication use in older adults undergoing surgery: a national study.| | View in PubMed
- Invited commentary. Gender influences treatment and survival in colorectal cancer surgery.| | View in PubMed
- Computed tomographic colonography for patients at high risk of colorectal cancer: trading accuracy for access and compliance.| | View in PubMed
- Research based on administrative data.| | View in PubMed
- Hospital factors and racial disparities in mortality after surgery for breast and colon cancer.| | View in PubMed
- Phenotype, distribution, generation, and functional and clinical relevance of Th17 cells in the human tumor environments.| | View in PubMed
- Reaction time performance in upper airway resistance syndrome versus obstructive sleep apnea syndrome.| | View in PubMed
- FOXP3 defines regulatory T cells in human tumor and autoimmune disease.| | View in PubMed
- Outcomes in octogenarians undergoing high-risk cancer operation: a national study.| | View in PubMed
- Laparoscopic colectomy for cancer.| | View in PubMed
- Predicting quality in surgery.| | View in PubMed
- Surgical treatment of insulinomas.| | View in PubMed
- Hospital volume, length of stay, and readmission rates in high-risk surgery.| | View in PubMed
- Hospital volume and operative mortality in cancer surgery: a national study.| | View in PubMed
- Effects of hospital volume on life expectancy after selected cancer operations in older adults: a decision analysis.| | View in PubMed
- Adjusting surgical mortality rates for patient comorbidities: more harm than good?| | View in PubMed
- Should consumers trust hospital quality report cards?| | View in PubMed
- Hospital volume and surgical mortality in the United States.| | View in PubMed
- Outcomes in vascular surgery: volume versus certification.| | View in PubMed
- Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative.| | View in PubMed
- Operative mortality with elective surgery in older adults.| | View in PubMed
- Sleep-disordered breathing and systemic hypertension in the older male.| | View in PubMed