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
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
- Patients with dementia or frailty undergoing major limb amputation have poor outcomes.| | PubMed
- Improving Surgical Care and Outcomes in Older Cancer Patients Through Implementation of a Presurgical Toolkit (OPTI-Surg)-Final Results of a Phase III Cluster Randomized Trial (Alliance A231601CD).| | PubMed
- Associations of Resilience, Perceived Control of Health, and Depression with Geriatric Outcomes after Surgery.| | PubMed
- Use of Muscle Relaxants After Surgery in Traditional Medicare Part D Enrollees.| | PubMed
- Clinician Perspectives on How Family Support and Psychological Distress Influence Older Adults' Recovery After Major Surgery.| | PubMed
- Association of Race and Ethnicity With Postoperative Gabapentinoid and Opioid Prescribing Trends for Older Adults.| | PubMed
- "It Gives Me Peace of Mind So I Can Focus on Healing": Views on Advance Care Planning for Older Surgical Patients.| | PubMed
- Risk factors and associated outcomes of postoperative delirium after open abdominal aortic aneurysm repair.| | PubMed
- Social Strain is associated with Functional Decline in Older Adults after Surgery.| | PubMed
- Reimagining Ambulatory Care in Urology: Conversion of the Urology Clinic into a Procedure Center Improves Patient's Experience.| | PubMed
- Clinician Review of Advanced Care Planning for Older Surgical Patients Requiring Intensive Care.| | PubMed
- Trends in the Use of Gabapentinoids and Opioids in the Postoperative Period Among Older Adults.| | PubMed
- Experiences with targeting inpatient advance care planning for emergency general surgery patients: A resident-led quality improvement project.| | PubMed
- Multisite Implementation of an American College of Surgeons Geriatric Surgery Quality Improvement Initiative.| | PubMed
- Cognitive Impairment is Common in a Veterans Affairs Population with Peripheral Arterial Disease.| | PubMed
- Missed Opportunities and Health Disparities for Advance Care Planning Before Elective Surgery in Older Adults.| | PubMed
- High risk of complications after a "low risk" procedure: A national study of nursing home residents and older adults undergoing haemorrhoid surgery.| | PubMed
- Prolonged use of newly prescribed gabapentin after surgery.| | PubMed
- "I Wish Someone had Asked Me Earlier"-Perspectives on Advance Care Planning in Surgery.| | PubMed
- Characteristics and Procedures Among Adults Discharged to Hospice After Gastrointestinal Tract Surgery in California.| | PubMed
- Functional and cognitive outcomes after suprapubic catheter placement in nursing home residents: A national cohort study.| | PubMed
- Patients living with dementia have worse outcomes when undergoing high-risk procedures.| | PubMed
- Reply by Authors.| | PubMed
- Frailty Is Associated with an Increased Risk of Complications and Need for Repeat Procedures after Sling Surgery in Older Adults.| | PubMed
- Ileostomy or ileal pouch-anal anastomosis for ulcerative colitis: patient participation and decisional needs.| | PubMed
- Frequency of Preoperative Advance Care Planning for Older Adults Undergoing High-risk Surgery: A Secondary Analysis of a Randomized Clinical Trial.| | PubMed
- Expressions of conflict following postoperative complications in older adults having major surgery.| | PubMed
- Comparative Outcomes for Pelvic Organ Prolapse Surgery among Nursing Home Residents and Matched Community Dwelling Older Adults. Reply.| | PubMed
- Comparative outcomes for older adults undergoing surgery for bladder and bowel dysfunction.| | PubMed
- Patient Factors Associated With Parathyroidectomy in Older Adults With Primary Hyperparathyroidism.| | PubMed
- An Implementation-Effectiveness Study of a Perioperative Delirium Prevention Initiative for Older Adults.| | PubMed
- Derivation, Validation, Sustained Performance, and Clinical Impact of an Electronic Medical Record-Based Perioperative Delirium Risk Stratification Tool.| | PubMed
- Reply by Authors.| | PubMed
- The American College of Surgeons Geriatric Surgery Verification Program and the Practicing Colorectal Surgeon.| | PubMed
- Preoperative Depressive Symptoms Associated with Poor Functional Recovery after Surgery.| | PubMed
- Comparative Outcomes for Pelvic Organ Prolapse Surgery among Nursing Home Residents and Matched Community Dwelling Older Adults.| | PubMed
- Living in a Food Desert is Associated with 30-day Readmission after Revascularization for Chronic Limb-Threatening Ischemia.| | PubMed
- Association of Functional, Cognitive, and Psychological Measures With 1-Year Mortality in Patients Undergoing Major Surgery.| | PubMed
- Patient complexity by surgical specialty does not correlate with work relative value units.| | PubMed
- Time Spent Away from Home in the Year Following High-Risk Cancer Surgery in Older Adults.| | PubMed
- Long-Term Trends in Postoperative Opioid Prescribing, 1994 to 2014.| | PubMed
- Effectiveness of a Question Prompt List Intervention for Older Patients Considering Major Surgery: A Multisite Randomized Clinical Trial.| | PubMed
- Including the Family in Perioperative Care of Older Adults-A Call for HELP.| | PubMed
- Is there a role for specialized geriatric centers in treating geriatric cancer patients?| | PubMed
- What Matters? The Valued Life Activities of Older Adults Undergoing Elective Surgery.| | PubMed
- The impact of frailty on treatment for overactive bladder in older adults.| | PubMed
- How Did We Get Here? A Broader View of the Postoperative Period.| | PubMed
- Invasive Procedures to Improve Function in Frail Older Adults: Do Outcomes Justify the Intervention?| | PubMed
- The Association Between Race and Frailty in Older Adults Presenting to a Nononcologic Urology Practice.| | PubMed
- Optimizing the Feasibility and Scalability of a Geriatric Surgery Quality Improvement Initiative.| | PubMed
- Functional Status and Survival After Breast Cancer Surgery in Nursing Home Residents.| | PubMed
- Depth of Propofol Sedation and Postoperative Delirium: The Jury Is Still Out.| | PubMed
- Increasing Advance Care Planning Using a Surgical Optimization Program for Older Adults.| | PubMed
- Patient Frailty Should Be Used to Individualize Treatment Decisions in Primary Hyperparathyroidism.| | PubMed
- Postoperative Delirium as a Target for Surgical Quality Improvement.| | PubMed
- Mortality and Functional Outcomes After Minor Urological Surgery in Nursing Home Residents: A National Study.| | 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.| | PubMed
- Association of Patient Frailty With Increased Morbidity After Common Ambulatory General Surgery Operations.| | PubMed
- Hospital Standards to Promote Optimal Surgical Care of the Older Adult: A Report From the Coalition for Quality in Geriatric Surgery.| | PubMed
- The American Society of Colon and Rectal Surgeons Clinical Practice Guideline for the Prevention of Venous Thromboembolic Disease in Colorectal Surgery.| | PubMed
- Treatment Intensity After Traumatic Brain Injury: More Is Not Better.| | PubMed
- Estimating Risk of Postsurgical General and Geriatric Complications Using the VESPA Preoperative Tool.| | PubMed
- Optimizing Surgical Quality Datasets to Care for Older Adults: Lessons from the American College of Surgeons NSQIP Geriatric Surgery Pilot.| | PubMed
- Frailty-Going From Measurement to Action.| | PubMed
- Author Reply.| | 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.| | PubMed
- Overactive Bladder Is Strongly Associated With Frailty in Older Individuals.| | PubMed
- The Timed Up and Go Test as a Measure of Frailty in Urologic Practice.| | PubMed
- Delivery Mode in Pregnant Patients with IBD: Uncertainty Remains.| | PubMed
- Impact of Multimodality Pain Regimens on Elective Colorectal Surgery Outcomes.| | PubMed
- A Call for Frailty Screening in the Preoperative Setting.| | PubMed
- Frailty and the Role of Obliterative versus Reconstructive Surgery for Pelvic Organ Prolapse: A National Study.| | PubMed
- Functional Outcomes After Transurethral Resection of the Prostate in Nursing Home Residents.| | PubMed
- Early learners as health coaches for older adults preparing for surgery.| | PubMed
- Changing Paradigms in Detection of Dysplasia and Management of Patients With Inflammatory Bowel Disease: Is Colectomy Still Necessary?| | PubMed
- Development of a Nonparametric Predictive Model for Readmission Risk in Elderly Adults After Colon and Rectal Cancer Surgery.| | PubMed
- Focus on Surgical Outcomes That Matter to Older Patients.| | PubMed
- Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study.| | PubMed
- Author Reply.| | PubMed
- Thinking Beyond Age for Postacute Care After Major Abdominal Surgery: A New Surgical Era.| | PubMed
- Preoperative Frailty Is Associated With Discharge to Skilled or Assisted Living Facilities After Urologic Procedures of Varying Complexity.| | PubMed
- A Novel Decision Aid for Surgical Patients with Ulcerative Colitis: Results of a Pilot Study.| | PubMed
- Postoperative Functional Outcomes in Older Adults.| | PubMed
- Surgical oncology outcomes in the aging US population.| | PubMed
- Center the Patient in the Decision Process: A Tool to Inform the Consent and Share the Decision-Making in Patients With Rectal Cancer.| | 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.| | PubMed
- Impact of Surgery on Relationship Quality in Patients With Ulcerative Colitis and Their Partners.| | PubMed
- Association of Reference Payment for Colonoscopy With Consumer Choices, Insurer Spending, and Procedural Complications.| | PubMed
- Impact of Patient Age on Procedure Type for Ulcerative Colitis: A National Study.| | PubMed
- Outcomes Analysis of Biologic Mesh Use for Abdominal Wall Reconstruction in Clean-Contaminated and Contaminated Ventral Hernia Repair.| | PubMed
- Functional outcomes after lower extremity revascularization in nursing home residents: a national cohort study.| | PubMed
- Outcomes after ileoanal pouch surgery in frail and older adults.| | PubMed
- Reply to N.H. Turner et al and Ł. Dziki et al.| | PubMed
- Perineal flap reconstruction following oncologic anorectal extirpation: an outcomes assessment.| | PubMed
- The significance of preoperative impaired sensorium on surgical outcomes in nonemergent general surgical operations.| | PubMed
- RAMPing up the quality of rectal cancer surgery.| | PubMed
- How to best forecast adverse outcomes following geriatric trauma: an ageless question?| | PubMed
- Preoperative assessment of the older patient: a narrative review.| | PubMed
- Advancing age and 30-day adverse outcomes after nonemergent general surgeries.| | 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| | PubMed
- Outcomes after rectal cancer surgery in elderly nursing home residents.| | PubMed
- Elective Surgery in Dialysis Patients: Comment on "Risk of Major Nonemergent Inpatient General Surgical Procedures in Patients on Long-term Dialysis"| | PubMed
- Functional status after colon cancer surgery in elderly nursing home residents.| | PubMed
- Major abdominal surgery in nursing home residents: a national study.| | PubMed
- Inappropriate medication use in older adults undergoing surgery: a national study.| | PubMed
- Invited commentary. Gender influences treatment and survival in colorectal cancer surgery.| | PubMed
- Computed tomographic colonography for patients at high risk of colorectal cancer: trading accuracy for access and compliance.| | PubMed
- Research based on administrative data.| | PubMed
- Hospital factors and racial disparities in mortality after surgery for breast and colon cancer.| | PubMed
- Phenotype, distribution, generation, and functional and clinical relevance of Th17 cells in the human tumor environments.| | PubMed
- Reaction time performance in upper airway resistance syndrome versus obstructive sleep apnea syndrome.| | PubMed
- FOXP3 defines regulatory T cells in human tumor and autoimmune disease.| | PubMed
- Outcomes in octogenarians undergoing high-risk cancer operation: a national study.| | PubMed
- Laparoscopic colectomy for cancer.| | PubMed
- Predicting quality in surgery.| | PubMed
- Surgical treatment of insulinomas.| | PubMed
- Hospital volume, length of stay, and readmission rates in high-risk surgery.| | PubMed
- Hospital volume and operative mortality in cancer surgery: a national study.| | PubMed
- Effects of hospital volume on life expectancy after selected cancer operations in older adults: a decision analysis.| | PubMed
- Adjusting surgical mortality rates for patient comorbidities: more harm than good?| | PubMed
- Should consumers trust hospital quality report cards?| | PubMed
- Hospital volume and surgical mortality in the United States.| | PubMed
- Outcomes in vascular surgery: volume versus certification.| | PubMed
- Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative.| | PubMed
- Operative mortality with elective surgery in older adults.| | PubMed
- Sleep-disordered breathing and systemic hypertension in the older male.| | PubMed