Take sleep deprivation stemming from a patient being in a noisy, unfamiliar surrounding, he suggested.
"This disruption can have debilitating behavioral and physiological effects: sleep deprivation adversely affects metabolism, cognitive performance, physical functioning and coordination, immune function, coagulation cascade, and cardiac risk," Krumholz wrote.
And then there is the issue of the patient's diet and nutrition, "which often receive limited attention."
In one study of Medicare-eligible patients, 20% had an average intake of fewer than 50% of their energy requirements, which could be because their procedures require they eat nothing for certain periods, which are prolonged when the tests or procedures need to be rescheduled.
"These deficits, rarely addressed at discharge, can lead to protein-energy malnutrition," Krumholz wrote. And that can lead to loss of weight and decreased blood albumen levels that are "strong predictors of readmission within 30 day," he wrote.
Malnutrition can impair wound healing, raise risk of infection, exacerbate pressure ulcers, decrease respiratory and cardiac function and result in poorer outcomes for lung disease.