Reflecting the first wave COVID-19 pandemic in Central Europe (i.e. March 16th-April 15th, 2020) the neurosurgical community witnessed a general diminution in the incidence of emergency neurosurgical cases, which was impelled by a reduced number of traumatic brain injuries (TBI), spine conditions, and chronic subdural hematomas (CSDH). This appeared to be associated with restrictions imposed on mobility within countries but also to possible delayed patient introduction and interdisciplinary medical counseling. In response to one year of COVID-19 experience, also mapping the third wave of COVID-19 in 2021 (i.e. March 16 to April 15, 2021), we aimed to reevaluate the current prevalence and outcomes for emergency non-elective neurosurgical cases in COVID-19-negative patients across Austria and the Czech Republic. The primary analysis was focused on incidence and 30-day mortality in emergency neurosurgical cases compared to four preceding years (2017-2020). A total of 5077 neurosurgical emergency cases were reviewed. The year 2021 compared to the years 2017-2019 was not significantly related to any increased odds of 30 day mortality in Austria or in the Czech Republic. Recently, there was a significant propensity toward increased incidence rates of emergency non-elective neurosurgical cases during the third COVID-19 pandemic wave in Austria, driven by their lower incidence during the first COVID-19 wave in 2020. Selected neurosurgical conditions commonly associated with traumatic etiologies including TBI, and CSDH roughly reverted to similar incidence rates from the previous non-COVID-19 years. Further resisting the major deleterious effects of the continuing COVID-19 pandemic, it is edifying to notice that the neurosurgical community´s demeanor to the recent third pandemic culmination keeps the very high standards of non-elective neurosurgical care alongside with low periprocedural morbidity. This also reflects the current state of health care quality in the Czech Republic and Austria.

Department of Neurosurgery and Neuro Oncology 1st Medical Faculty Central Military Hospital Charles University Prague Czech Republic

Department of Neurosurgery and Neurorestauration Klinikum Klagenfurt Klagenfurt Austria

Department of Neurosurgery Ceske Budejovice Hospital Ceske Budejovice Czech Republic

Department of Neurosurgery Christian Doppler Clinic Paracelsus Medical University Salzburg Austria

Department of Neurosurgery General Hospital Wiener Neustadt Wiener Neustadt Austria

Department of Neurosurgery Kepler University Hospital GmbH Johannes Kepler University Linz Austria

Department of Neurosurgery Klinik Donaustadt Vienna Austria

Department of Neurosurgery Landeskrankenhaus Feldkirch Feldkirch Austria

Department of Neurosurgery Liberec Hospital Liberec Czech Republic

Department of Neurosurgery Medical University Graz Graz Austria

Department of Neurosurgery Medical University Innsbruck Innsbruck Austria

Department of Neurosurgery Medical University of Vienna Vienna Austria

Department of Neurosurgery Motol University Hospital Prague Czech Republic

Department of Neurosurgery Pilsen University Hospital Pilsen Czech Republic

Department of Neurosurgery St Anne's University Hospital Brno and Masaryk University Brno Czech Republic

Department of Neurosurgery University Hospital Brno and Masaryk University Brno Czech Republic

Department of Neurosurgery University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Neurosurgery University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Neurosurgery University Hospital of St Poelten Karl Landsteiner University of Health Sciences St Poelten Austria

Department of Neurosurgery University Hospital Olomouc Olomouc Czech Republic

Department of Neurosurgery University Hospital Ostrava Ostrava Czech Republic

Department of Neurosurgery Usti Nad Labem Hospital Usti Nad Labem Czech Republic

International Collaboration on Repair Discoveries University of British Columbia Vancouver BC Canada

Unit of Neurosurgery Homolka Hospital Prague Czech Republic

Unit of Neurosurgery Klinik Landstrasse Vienna Austria

Unit of Neurosurgery Municipal Hospital Ostrava Fifejdy Ostrava Czech Republic

Unit of Neurosurgery Pardubice Hospital Pardubice Czech Republic

Unit of Neurosurgery Zlin Hospital Zlin Czech Republic

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