Objective To explore the clinical characteristics of patients with epistaxis in Tianmen City, and analyze the influence of air pollution levels and meteorological factors on the risk of inpatient surgery, so as to provide a basis for clinical prevention and public health intervention. Methods A retrospective study was conducted to collect the data of patients with epistaxis who visited Tianmen First People’s Hospital from January 1, 2022 to December 31, 2024, including gender, age, time of visit and hospitalization surgery situation. The air pollutant and meteorological data during the same period were obtained from the Hubei Provincial Department of Ecology and Environment, the National Oceanic and Atmospheric Administration of the United States. Descriptive statistics and Spearman correlation analyses were performed on environmental factors. Univariate and multivariate logistic regression analyses were conducted using inpatient surgery as the outcome variable. Results A total of 9 803 cases with epistaxis were included. During the same period, the average concentrations of PM2.5, PM10, and O₃ were 36.07, 71.17, and 103.18 μg/m³, respectively, while the average values of SO₂, CO, and NO₂ were 7.06 μg/m³, 0.73 mg/m³, and 16.41 μg/m³ respectively. The average air quality index (AQI) was 75.85, the average temperature was 18.48℃, the average wind speed 4.19 m/s, and median humidity was 56.8%. The Spearman correlation analysis showed that PM2.5 had the strongest correlation with PM10 (r=0.91), and the concentrations of most air pollutants were negatively correlated with average temperature, average humidity, and average wind speed (r=-0.18 to -0.64); the number of patients seeking medical treatment was positively correlated with average temperature and average humidity (r=0.32 to -0.40), and negatively correlated with air pollutants (r=-0.26 to -0.04). The number of patients seeking medical treatment showed a trend of being higher in spring and summer and lower in autumn and winter. The AQI classification indicated that the air quality on the days when most patients (7 892 cases) sought medical treatment was distributed in the “good” and “excellent” categories. Multivariate regression analysis showed that PM2.5, average temperature, and average wind speed reduced the risk of hospitalization for surgery (OR=0.988, 0.952, 0.954), while SO₂ (OR=1.089) and CO (OR=1.762) increased the risk. Moderate (OR=3.064) and severe pollution (OR=4.348) significantly increased the probability of surgery. Conclusions Epistaxis in Tianmen City shows distinct temporal distribution and demographic characteristics, with air pollution and meteorological factors significantly affecting the risk of hospitalization and surgery. Controlling the levels of SO₂ and CO and improving overall air quality are expected to reduce the severity of epistaxis and the risk of surgery.