Background: Routine early postoperative CT (EPCT) in neurologically intact patients is unsupported but still common. Recent studies suggest 135 scans are needed to detect one clinically silent abnormality (Blumrich, 2021). This study assessed the rate and utility of EPCT, defined as a CT head scan within 24 hours of adult craniotomy. Methods: Retrospective review of adult craniotomy cases at the University of Alberta Hospital was conducted over a 10-month period. Data on EPCT rates, timing, adverse findings (complication or unfavourable outcome, e.g., bleeding, extensive pneumocephalus, edema, ischemia), as well as clinical data on neurologic deterioration (e.g., weakness, aphasia, visual impairment, decreased LOC), and repeat surgical interventions were extracted. Results: Of 405 patients (200 female, 54.6 ± 0.8 years, range: 19-89), 96.5% (391/405) underwent EPCT. Adverse EPCTs occurred in 9.2% (36/391), with neurologic deterioration in 7.7% (30/391) and repeat surgery in 2.8% (11/391). Adverse scans and neurologic deterioration were strongly correlated (X2=141.1, p=1.54e-32). Only 0.5% (2/405) of EPCT findings prompting surgery lacked prior neurologic deterioration. Conclusions: EPCT in the absence of neurologic deterioration has a low yield for surgical intervention and may be safely omitted.