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Improvements in survival after burns have resulted in more patients being discharged home after severe injury. However, the postdischarge health care needs of burn survivors are not well understood. We aimed to determine the rate and causes of unplanned presentation to acute care facilities in the 5 years after major burn injury.Data derived from several population-based administrative databases were used to conduct a retrospective cohort study. All patients aged ≥16 years who survived to discharge after a major burn injury in 2003–2013 were followed for 1–5 years. All emergency department visits and unplanned readmissions were identified and classified by cause. Factors associated with emergency department visits were modeled using negative binomial generalized estimating equations. Factors associated with readmission were modeled using multivariable competing risk regression.We identified 1,895 patients who survived to discharge; 68% of patients had at least one emergency department visit and 30% had at least one readmission. Five-year mortality was 10%. The most common reason for both emergency department visits and readmissions was traumatic injury. After risk adjustment, patients who received their index care in a burn center experienced significantly less need for subsequent unplanned acute care, fewer emergency department visits (relative risk 0.61, 95% confidence interval, 0.52–0.72), and fewer hospital readmissions (hazard ratio 0.77, 95% confidence interval, 0.65–0.92).Acute health care utilization is frequent after burn injury and is most commonly related to traumatic injuries. Burn-related events are uncommon beyond 30 days after discharge, suggesting low rates of burn recidivism. Patients treated at burn centers have significantly reduced unplanned health care utilization after their injury.