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012), and non-Northeast region hospitals (P less then 0.02. Surgical management was associated with decreased mortality, increased length of stay, and increased total hospital charges (P less then 0.001). CONCLUSIONS Decompressive surgery rates for PSI differ significantly across regions and institutions in the United States. Institutional bias, patient preferences, and regional practice patterns all influence decision-making in PSI. A lack of large outcome studies in PSI and the absence of national guidelines contribute to variation