ObjectiveTo explore the necessity of routine X-ray examination after lung surgery based on patient symptom burden. MethodsA retrospective study was conducted on the patients who underwent thoracoscopic lung resection at the Department of Thoracic Surgery of Guangdong Provincial People's Hospital from March 2020 to April 2023. The routine chest X-ray examination results and symptom burden of postoperative patients were analyzed. Symptom burden was evaluated using the Perioperative Symptom Assessment Lung inventory. Results A total of 2 101 patients were collected, including 915 males and 1 100 femals, with a median age of 56 years. Among patients who underwent routine postoperative chest X-ray, only 1.0% patients accepted intervention. Among patients who had chest X-ray after chest tube removal, only 0.5% of them needed intervention. Among patients who had chest X-ray one month after discharge, only 1.3% of them required intervention. The intervention group had significantly worse shortness of breath (3 points vs. 2 points, P=0.015), pain (2 points vs. 1 point, P=0.039), and disturbed sleep (3 points vs. 2 points, P=0.036) compared with the normal group. Conclusion Very few routine postoperative chest X-ray examinations change patients’ management, and patients who need extra-intervention tended to have more severe symptom burden after surgery.