{'fraction_non_alphanumeric': 0.019632414369256473, 'fraction_numerical': 0.0029239766081871343, 'mean_word_length': 5.36968085106383, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Actual involvement vs preference for involvement as an indicator of shared decision making.

that are not evident in billing claims data. The entire clinical picture at presentation, past and present, will influence therapeutic decisions as well as eventual patient outcomes. We suggest selection bias is the unmeasured factor allowing 2 “theoretically” equivalent groups to have such different outcomes. We did consider the possibility that clinicians may preferentially perform spinal augmentation on the sickest patients so as to maximize their chances of survival—emergent spinal augmentation, if you will. Complications should then be highest immediately before the procedure, as patients clinically declare their need for more aggressive care. As Figure 2B in our article illustrates, however, preprocedure complications were less than postprocedure complications.1 In fact, there was a nadir in complications immediately before the procedure and a spike immediately after the procedure. We interpret these results to indicate that the majority of patients are not undergoing augmentation because of dire clinical need. Several methodological clarifications may be helpful. First, we did not stratify by treatment type (vertebroplasty vs kyphoplasty) in our analysis. However, we have compared these 2 treatments using these data and found no benefit of kyphoplasty over vertebroplasty. A recent randomized clinical trial comparing vertebroplasty with kyphoplasty also did not find benefit of one over the other.3 Second, we collected “baseline” comorbid conditions over the entire year prior to fracture. We included osteoporosis in that list, presumably the cause of the fracture. Unlike Edidin et al,2 we excluded all patients with diagnoses of cancer so as not to mix fractures due to metastases with those due to osteoporosis. Third, we used the date of fracture as baseline so that both groups would be compared relative to the same exposure (fracture) rather than starting the comparison when the augmented group had their procedure, which could be as late as 6 months later. Finally, Edidin et al failed to note in their letter that at the time of their article demonstrating the mortality benefits of spinal augmentation and, in particular, kyphoplasty, over conservative therapy, Dr Edidin was an employee and stockowner of Medtronic Inc, a manufacturer of kyphoplasty supplies.