High-risk surgeries significantly impact sleep quality, essential for recovery.

• High-risk procedures showed reduced REM and deep sleep lasting through day 7 (deep sleep: -18.7 minutes; REM: -12.4 minutes; p < 0.001).
• Acute reductions in total sleep were also noted (-19.4 minutes; p = 0.004).

Complications increased with less total sleep; each 10-minute drop raised odds of grade I/II complications by 13%.

• Opioid use correlated with increased light and wake sleep, but reduced deep sleep.