ObjectiveTo explore the necessity of routine X-ray examination after lung surgery based on patient symptom burden. MethodsA retrospective study was conducted including patients underwent thoracoscopic lung resection in the Department of Thoracic Surgery at uangdong Provincial People's Hospital from March 2020 to April 2023. Symptom burden was evaluated using the Perioperative Symptom Assessment Lung inventory. Results A total of 2 101 patients were included in the analysis. The median age was 56 years and 52.3% of included patients were female. Among patients who underwent routine postoperative chest X-ray, only 1% 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 vs. 2, P<0.05), pain (2 point vs. 1 point, P=0.039), and disturbed sleep (3 vs. 2, P<0.05) compared with the normal group. Conclusion Very few routine postoperative chest X-ray examinations changed patients’ management, and patients who needed extra intervention tended to have more severe symptom burden after surgery.