Background: Total joint arthroplasty (TJA) alongside bariatric surgery (BS) is frequently operated on in obese arthritis patients. The controversy persists regarding BS before TJA, and the extent of its impact on the prognosis of TJA patients remains uncertain. To explore this, we conducted a meta-analysis. Methods: As of 1 October 2023, the latest search on PubMed, Cochrane Library, Embase, and Web of Science was conducted to compare outcomes between patients who underwent preoperative BS and those who did not. The analysis focused on parameters such as length of stay (LOS), infection risk, venous thromboembolism, revision, transfusions, dislocations, periprosthetic fractures, knee stiffness, medical complications, and all-cause mortality in the eligible studies. Results: This meta-analysis included 18 trials with a total of 292 196 patients. Pooled findings indicated that preoperative BS significantly shortened the LOS (MD, −0.16; 95% CI, −0.25 to 0.07; I ² =58%; P =0.0004) and increased the risk of dislocation within 90 days (OR, 1.70; 95% CI, 1.20– ² .42; I ² =21%; P =0.003) and all-cause mortality within 30 days (OR, 3.69; 95% CI, 1.81–7.49; I ² = 0%; P =0.0003) for TJA, in comparison with patients without BS. In the total hip arthroplasty (THA) subgroup, BS was more favorable, exhibiting significantly reduced risk of short-term revision (OR, 0.77; 95% C I , 0.61–0.99; I ² =0%; P =0.04) and long-term infection (OR, 0.72; 95% CI, 0.61–0.85; I ² =0%; P ≤0.0001). For total knee arthroplasty (TKA) patients, no significant benefit was identified. In addition, there was no statistically significant correlation between preoperative or postoperative BS and the occurrence of complications in TJA patients. Conclusions and Relevance: Compared with the control group without BS, preoperative BS can shorten the LOS, increase the risk of dislocation within 90 days and all-cause mortality within 30 days in TJA, and reduce the risk of specific surgical complications in the THA subgroup but shows no significant difference in the TKA subgroup. There are no differences in clinical outcomes whether BS is performed before or after TJA. More high-quality trials are needed to further clarify the impact of BS on obese patients undergoing TJA.

Vascular Intestinal Disorder (VID) significantly impacts the global disease burden, with notable regional variations in incidence, prevalence, and Disability-Adjusted Life-Years (DALYs). While high-income countries have seen a decline in VID burden due to improved healthcare, lower-income regions continue to face rising VID rates. Understanding these trends is essential for developing effective health policies and interventions. This study aimed to analyze the global trends in VID incidence, prevalence, and DALYs from 1990 to 2021. We utilized data from the global burden of disease study to calculate age-standardized rates for incidence, prevalence, and DALYs of VID from 1990 to 2021. Joinpoint regression analysis was performed to assess trend changes over time. An age-period-cohort analysis explored the impact of age, period, and birth cohort on VID burden. Decomposition, inequality, and frontier analyses were conducted to investigate the contributions of aging, population growth, and epidemiological changes to the VID burden. Overall, the global trends of VID incidence, prevalence, and DALYs showed a decline over the past 3 decades. However, regional disparities were evident. High and upper-middle socio-demographic index (SDI) regions saw significant declines in both incidence and prevalence, while low and lower-middle SDI regions experienced increases. DALYs showed a decreasing trend in most regions, though certain areas, including Central Asia and Eastern Europe, demonstrated increases. The age-period-cohort analysis revealed that age is a significant determinant of VID burden, with incidence, prevalence, and DALYs increasing with age. Population growth and aging were found to be the main drivers of increased VID burden, while epidemiological changes contributed to a global reduction in VID burden. Inequality analysis showed persistent disparities, with low-SDI regions bearing a disproportionate share of the VID burden. Policymakers must focus on addressing health inequalities and ensuring equitable distribution of global health interventions. Future research should investigate the specific causes and subtypes of VID, and improve global health data monitoring to better predict and manage shifts in disease burden.

Background: Previous meta-analyses have extensively compared the outcomes of intravascular imaging-guided versus coronary angiography-guided percutaneous coronary intervention (PCI) in the treatment of coronary artery disease. However, conducting repeated meta-analyses within a short period may increase the probability of type I or type II errors. Therefore, we employed both traditional meta-analysis and trial sequential analysis (TSA) methods to compare the clinical outcomes of intravascular imaging-guided and coronary angiography-guided PCI. Methods: We searched PubMed, Cochrane Library, Embase, and Web of Science for literature comparing intravascular imaging-guided versus coronary angiography-guided PCI from inception to August 10, 2024. Four researchers, divided into 2 groups, independently extracted the data. The primary outcomes were major adverse cardiovascular events (MACEs) and target lesion failure (TLF). Secondary outcomes included stent thrombosis and all-cause mortality. TSA was used to analyze these outcomes. Results: A total of 23 randomized controlled trials with 17,766 participants were included. Compared to angiography, intravascular ultrasound has a significant advantage in reducing MACE (risk ratio [RR]: 0.66; 95% confidence interval [CI]: 0.55–0.80) and TLF (RR: 0.64; 95% CI: 0.54–0.75) during follow-up, supported by high certainty of evidence and confirmed by an 80% power TSA, demonstrating a true positive effect. However, no significant differences were observed in reducing stent thrombosis or all-cause mortality. Similarly, compared to angiography, optical coherence tomography shows a significant advantage in reducing MACE beyond 1 year (RR: 0.79; 95% CI: 0.64–0.99), but further exploration is needed, given that only 3 studies were included. In other aspects, including the reduction of stent thrombosis and all-cause mortality, no significant differences were found. Conclusion: Intravascular ultrasound showed truly superior efficacy in reducing MACE and TLF compared to angiography. However, additional studies are needed to further assess the effectiveness of optical coherence tomography.