BACKGROUND: Respiratory papillomatosis (RP) is a benign tumor that primarily affects the respiratory tract and is often caused by human papillomavirus (HPV). Patients typically require multiple surgeries. Recent studies suggest that age may significantly influence the frequency of surgeries, although specific research on this correlation remains limited. METHODS: This study retrospectively analyzed data from 676 RP patients who underwent surgery between 2000 and 2022 at a specific hospital. Patients were divided into two groups: those over 18 years old and those 18 years old or younger. This study examined the impact of factors such as age, weight, length of hospital stay, and HPV infection on the number of operations. Smooth curve fitting and threshold effect analysis were employed to explore the nonlinear relationship between age and surgery frequency. Univariate and multivariate regression analyses, along with a generalized additive model, were used to investigate the associations between age and the number of surgeries. RESULTS: This study analyzed data from 676 patients with respiratory papillomatosis and revealed a significant nonlinear relationship between age and the number of operations. The results revealed that younger patients, especially those under 18 years of age, needed more surgeries, with an average of 5.5 surgeries per year, whereas adult patients had an average of only 1.7 surgeries. Through generalized additive modeling, we established that 8.2 years is a critical inflection point
below this age, each additional year is associated with a decrease of 0.7 surgeries (95% CI [-0.8, -0.6], P <
0.002), whereas the frequency stabilizes above this age. Multivariable regression analysis further confirmed the significant impact of age on surgical frequency, maintaining this association even when adjusting for other variables (β= -2.16, 95% CI [-2.97, -1.36], P <
0.002). CONCLUSION: Age is a crucial factor influencing the frequency of surgeries in RRP patients, with this effect being particularly pronounced in younger patients. Notably, below the critical age of 8.2 years, the number of surgeries increases significantly. This finding provides important insights for clinical practice, aiding in the development of more precise treatment strategies and prognostic assessments.