Boston Scientific Corp (BSX) 2022 Q3 法說會逐字稿

Good morning, and welcome to the Boston Scientific Third Quarter 2022 Earnings Call. (Operator Instructions) Please note, this event is being recorded.

早上好，歡迎參加波士頓科學公司 2022 年第三季度財報電話會議。 （操作員說明）請注意，此事件正在記錄中。

I would now like to turn the conference over to Lauren Tengler, Vice President, Investor Relations. Please go ahead.

我現在想將會議轉交給投資者關係副總裁 Lauren Tengler。請繼續。

Thank you, Andrew. Welcome, everyone, and thanks for joining us today. With me on today's call are Mike Mahoney, Chairman and Chief Executive Officer; and Dan Brennan, Executive Vice President and Chief Financial Officer.

謝謝你，安德魯。歡迎大家，感謝您今天加入我們。今天與我通話的還有董事長兼首席執行官邁克·馬奧尼（Mike Mahoney）；以及執行副總裁兼首席財務官 Dan Brennan。

We issued a press release earlier this morning announcing our Q3 2022 results which included reconciliations of the non-GAAP measures used in the release. We have posted a copy of that release, as well as reconciliations of the non-GAAP measures used in today's call, to the Investor Relations section of our website under the heading Financials and Filings.

我們今天早上早些時候發布了一份新聞稿，宣布了我們的 2022 年第三季度業績，其中包括對發布中使用的非公認會計原則措施的對賬。我們已將該新聞稿的副本以及今天電話會議中使用的非公認會計原則措施的對賬發佈到我們網站的投資者關係部分，標題為財務和文件。

The duration of this morning's call will be approximately 1 hour. Mike and Dan will provide comments on Q3 performance as well as the outlook for our business, including Q4 '22 and full year '22 guidance. And then we'll take your questions. During today's Q&A session, Mike and Dan will be joined by our Chief Medical Officers, Dr. Ian Meredith; and Dr. Ken Stein.

今天上午的通話時間大約為 1 小時。 Mike 和 Dan 將就第三季度的業績以及我們的業務前景發表評論，包括 22 年第四季度和 22 年全年指導。然後我們會回答你的問題。在今天的問答環節中，我們的首席醫療官 Ian Meredith 博士將加入 Mike 和 Dan；和肯斯坦博士。

Before we begin, I'd like to remind everyone that on the call, operational revenue growth excludes the impact of foreign currency fluctuation and organic revenue growth further excludes acquisitions and divestitures for which there are less than a full period of comparable net sales. Relevant acquisitions include -- excluded for organic growth are Preventice, FARAPULSE and Lumenis Surgical, which closed in March, August and September of 2021, respectively; as well as Baylis Medical, which closed on February 14, 2022. Divestitures include the BTG Specialty Pharmaceuticals, which closed on March 1, 2021. Guidance excludes the previously announced agreement to purchase the majority stake of M.I. Tech, which is expected to close by year-end 2022.

在我們開始之前，我想提醒大家，在電話會議上，營業收入增長排除了外匯波動的影響，有機收入增長進一步排除了可比淨銷售額不到一個完整時期的收購和資產剝離。相關收購包括——不包括有機增長的是Preventice、FARAPULSE和Lumenis Surgical，它們分別於2021年3月、8月和9月完成；以及於 2022 年 2 月 14 日關閉的 Baylis Medical。剝離包括於 2021 年 3 月 1 日關閉的 BTG Specialty Pharmaceuticals。指南不包括先前宣布的收購 M.I. 多數股權的協議。 Tech，預計將於 2022 年底關閉。

For more information, please refer to our financial and operating highlights deck, which may be found on our Investor Relations website. On this call, all references to sales and revenue, unless otherwise specified, are organic.

欲了解更多信息，請參閱我們的財務和運營亮點板塊，該板塊可在我們的投資者關係網站上找到。在這次電話會議上，除非另有說明，否則所有提及銷售和收入的內容都是有機的。

This call contains forward-looking statements within the meaning of federal securities laws, which may be identified by words like anticipate, expect, may, believe, estimate and other similar words. They include, among other things, statements about our growth and market share; new and anticipated product approvals and launches; acquisitions; clinical trials; cost savings and growth opportunities; our cash flow and expected use; our financial performance, including sales, margins and earnings, as well as our tax rates, R&D spend and other expenses. If our underlying assumptions turn out to be incorrect or if certain risks or uncertainties materialize, actual results could vary materially from the expectations and projections expressed or implied by our forward-looking statements. Factors that may cause such differences include those described in the Risk Factors section of our most recent 10-K and subsequent 10-Qs filed with the SEC. These statements speak only as of today's date, and we disclaim any intention or obligation to update them.

本次電話會議包含聯邦證券法含義內的前瞻性陳述，這些陳述可以通過預期、期望、可能、相信、估計等詞語和其他類似詞語來識別。其中包括，除其他外，關於我們的增長和市場份額的陳述；新的和預期的產品批准和發布；收購；臨床試驗;成本節約和增長機會；我們的現金流和預期用途；我們的財務業績，包括銷售額、利潤率和收益，以及我們的稅率、研發支出和其他費用。如果我們的基本假設被證明是不正確的，或者如果某些風險或不確定性成為現實，實際結果可能與我們的前瞻性陳述所表達或暗示的預期和預測存在重大差異。可能導致此類差異的因素包括我們最近向 SEC 提交的 10-K 和後續 10-Q 的風險因素部分中描述的因素。這些聲明僅在今天發表，我們不承擔任何更新它們的意圖或義務。

At this point, I'll turn it over to Mike for his comments.

在這一點上，我將把它交給邁克以徵求他的意見。

Thanks, Lauren, and thank you to everyone for joining us here today. We're very proud of our performance in the third quarter, particularly in light of the ongoing macroeconomic and supply chain headwinds. Our performance continues to be supported by the strength and diversification of our innovative portfolio and the winning spirit of our global team.

謝謝，勞倫，感謝大家今天加入我們。我們對第三季度的表現感到非常自豪，特別是考慮到持續的宏觀經濟和供應鏈逆風。我們的業績繼續得到我們創新產品組合的實力和多元化以及我們全球團隊的勝利精神的支持。

Third quarter '22 total company operational sales grew 14% versus prior year. And organic sales grew 11.5%, which does exceed the high end of our guidance range of 8% to 10%. This performance is a testament to our category leadership strategy and focus on innovation with strong commercial execution. 6 of 8 of our business units grew double digits organically, and we believe that nearly all of our businesses and regions grew faster than their respective markets. Third quarter adjusted EPS of $0.43 grew 6.3% versus prior year, at the low end of our guidance range of $0.43 to $0.45, attributable to increased FX headwinds and slightly higher spend within the quarter.

22 年第三季度公司總運營銷售額與去年同期相比增長了 14%。有機銷售額增長了 11.5%，確實超過了我們 8% 至 10% 的指導範圍的高端。這一表現證明了我們的品類領先戰略，並專注於創新和強大的商業執行。我們 8 個業務部門中有 6 個實現了兩位數的有機增長，我們相信幾乎所有業務和地區的增長速度都快於各自的市場。第三季度調整後每股收益為 0.43 美元，較上年同期增長 6.3%，處於我們指導範圍 0.43 美元至 0.45 美元的低端，這歸因於本季度外匯逆風增加和支出略高。

We have grown 9.2% organically year-to-date through third quarter. And in light of this performance, we are increasing our full year '22 guidance for operational growth to approximately 11.5% and organic growth to approximately 9%. For fourth quarter '22 revenue, we're guiding to operational growth of 8.5% to 10.5% and organic growth of 7% to 9%. We're also updating our full year '22 adjusted EPS guidance to $1.71 to $1.74, primarily related to the ongoing headwind from foreign exchange. Our fourth quarter '22 adjusted EPS estimate is $0.45 to $0.48.

截至第三季度，我們今年迄今的有機增長率為 9.2%。鑑於這一表現，我們將 22 年全年運營增長指導提高至約 11.5%，有機增長提高至約 9%。對於 22 年第四季度的收入，我們指導運營增長率為 8.5% 至 10.5%，有機增長率為 7% 至 9%。我們還將 22 年全年調整後的每股收益指引更新至 1.71 美元至 1.74 美元，這主要與來自外彙的持續逆風有關。我們對 22 年第四季度調整後的每股收益估計為 0.45 美元至 0.48 美元。

Throughout 2022, we have maintained our goal to improve operating margins. While our goal remains, we feel it's prudent to provide an updated adjusted operating margin target of approximately 26%, considering the continued macroeconomic pressures. On a full year basis, this does represent approximately 70 basis points of margin expansion versus our 2021 rate of 25.3%.

在整個 2022 年，我們一直保持提高營業利潤率的目標。儘管我們的目標仍然存在，但考慮到持續的宏觀經濟壓力，我們認為提供約 26% 的最新調整後營業利潤率目標是謹慎的做法。在全年的基礎上，這確實代表了大約 70 個基點的利潤率擴張，而我們 2021 年的利率為 25.3%。

I'll now provide additional third quarter highlights along with some comments on future outlook. Regionally, the U.S. delivered operational growth of 12% versus prior year. Strong growth was realized across most all of our businesses -- business units, particularly cardiovascular and endoscopy, and included an approximate 300 basis point tailwind from acquisitions.

我現在將提供額外的第三季度亮點以及對未來前景的一些評論。從地區來看，美國的運營業務較上年增長了 12%。我們的大部分業務都實現了強勁增長——業務部門，特別是心血管和內窺鏡檢查，其中包括來自收購的大約 300 個基點的順風。

Middle East -- I'm sorry. Europe, Middle East and Africa grew 15% on an operational basis versus prior year. We continue to see excellent execution fueled by our innovative portfolio, with 7 of the 8 business units growing double digits. Sales growth accelerated within our growth/emerging market countries within Europe, with notable strength across cardiology and peripheral interventions.

中東——對不起。歐洲、中東和非洲在運營基礎上比上一年增長了 15%。我們繼續看到我們的創新產品組合推動了出色的執行，8 個業務部門中有 7 個實現了兩位數的增長。我們在歐洲的增長/新興市場國家的銷售增長加速，在心髒病學和外圍干預方面具有顯著優勢。

In Asia Pac, we grew 15% operationally with strong growth in China, India and ASEAN countries. While our Japan results saw some impact from COVID within the quarter, we continue to see strength driven by new products, including POLARx, WATCHMAN FLX and Rezum. Our team in China delivered excellent results in the third quarter with growth of 36%. Growth is primarily driven by our ICTx business within cardiovascular, PI and our CRM business units, supported by new and ongoing product launches across the portfolio.

在亞太地區，我們的運營增長了 15%，中國、印度和東盟國家的增長強勁。雖然我們在日本的業績在本季度受到了 COVID 的一些影響，但我們繼續看到新產品的推動力，包括 POLARx、WATCHMAN FLX 和 Rezum。我們在中國的團隊在第三季度取得了優異的成績，增長了 36%。增長主要由我們在心血管、PI 和我們的 CRM 業務部門內的 ICTx 業務推動，並得到整個產品組合中新的和正在進行的產品發布的支持。

Turning to Latin America. The team executed another exceptional quarter, growing 29% operationally.

轉向拉丁美洲。該團隊執行了另一個出色的季度，運營增長了 29%。

All business units in major markets grew double digits in the third quarter. And across the portfolio, more than 10 new products were launched, enabled by remote training and support.

第三季度主要市場的所有業務部門均實現兩位數增長。在整個產品組合中，通過遠程培訓和支持推出了 10 多種新產品。

I'll now provide some thoughts on our business units, starting with Urology and Pelvic Health, which grew organic sales 13% and 16% on an operational basis. The stone management, prosthetic urology and prostate health franchises all grew double digits in third quarter, with balanced performance across the regions.

我現在將提供一些關於我們業務部門的想法，從泌尿科和骨盆健康開始，它們的有機銷售額在運營基礎上分別增長了 13% 和 16%。結石管理、修復泌尿科和前列腺健康專營權在第三季度均實現兩位數增長，各地區表現均衡。

We continue to focus on global expansion and are pleased to have received approval and commenced the launches of SpaceOAR in both Korea and Mexico and Rezum in Japan. Our Lumenis acquisition did turn organic in September. And we remain excited about the global opportunity ahead with the Moses laser technology, LithoVue Single-Use flexible ureteroscopes and our broad portfolio of stone management products.

我們繼續專注於全球擴張，並很高興獲得批准並開始在韓國和墨西哥發射 SpaceOAR，在日本發射 Rezum。我們對 Lumenis 的收購確實在 9 月份實現了有機收購。我們仍然對 Moses 激光技術、LithoVue 一次性柔性輸尿管鏡和我們廣泛的結石管理產品組合所帶來的全球機遇感到興奮。

In Endoscopy, sales grew 10% organically. This category-leading business continues to focus on product innovations, enhanced by best-in-class physician education and training. Growth in the quarter was driven by our biliary and single-use imaging franchises with ongoing market development activities enabling increased utilization of EXALT-D and other key products.

在內窺鏡領域，銷售額有機增長了 10%。這一類別領先的業務繼續專注於產品創新，並通過一流的醫生教育和培訓得到加強。本季度的增長是由我們的膽道和一次性成像特許經營推動的，正在進行的市場開發活動提高了 EXALT-D 和其他關鍵產品的利用率。

In Neuromodulation, organic revenue grew 3%. Our pain franchise sales were flat year-over-year, below our expectations, with ongoing reimbursement challenges impacting U.S. procedures for both Vertiflex and spinal cord stimulation.

在神經調節方面，有機收入增長了 3%。我們的疼痛特許經營銷售額同比持平，低於我們的預期，持續的報銷挑戰影響了美國 Vertiflex 和脊髓刺激的程序。

In SCS, while international growth was very strong with broad demand for WaveWriter Alpha, our U.S. SCS sales were impacted by preauthorization denials despite strong patient demand and ongoing physician interest in our FAST therapy. We have a team in place focused on supporting the preauthorization documentation requirements. However, we do anticipate that challenges will continue to persist in the fourth quarter.

在 SCS 中，雖然國際增長非常強勁，對 WaveWriter Alpha 的廣泛需求，但我們的美國 SCS 銷售受到預授權拒絕的影響，儘管患者需求強勁且醫生對我們的 FAST 療法持續感興趣。我們有一個團隊專注於支持預授權文檔要求。但是，我們確實預計挑戰將在第四季度繼續存在。

In deep brain stimulation, the U.S., EMEA and LatAm regions grew double digits in the third quarter. Globally, we're seeing stable underlying DBS procedure growth, and we continue to see momentum in the U.S. as we moved into full launch of our STIMVIEW XT integrated imaging and programming platforms.

在深部腦刺激方面，美國、歐洲、中東和非洲地區和拉丁美洲地區在第三季度增長了兩位數。在全球範圍內，我們看到了穩定的基礎 DBS 程序增長，並且隨著我們全面推出 STIMVIEW XT 集成成像和編程平台，我們繼續看到美國的勢頭。

Cardiology delivered another excellent quarter with organic sales growing 13% and operational sales growing 16%. Within Cardiology, interventional cardiology therapies' organic sales grew 11%. This coronary therapies franchise performed well in third quarter, driven by strong performance in our international regions, particularly with our differentiated imaging franchise. Importantly, we recently completed enrollment in our AGENT IDE trial. This is the very first U.S. trial for a coronary drug-coated balloon to treat in-stent restenosis. And we expect to launch in Japan in '23, in the U.S. in 2024.

心髒病學又一個出色的季度實現了有機銷售額增長 13%，運營銷售額增長 16%。在心髒病學領域，介入心髒病學療法的有機銷售額增長了 11%。由於我們在國際地區的強勁表現，特別是我們差異化的成像專營權，這一冠狀動脈治療專營權在第三季度表現良好。重要的是，我們最近完成了 AGENT IDE 試用的註冊。這是美國第一個用冠狀藥物塗層球囊治療支架內再狹窄的試驗。我們預計將於 23 年在日本推出，2024 年在美國推出。

Our structural heart valves franchise did grow double digits in the third quarter again with continued strength in Europe with our ACURATE neo2 TAVR platform. Additionally, results from the PROTECTED TAVR trial were presented as a late-breaker at TCT. Recall, the PROTECTED TAVR trial studied our cerebral embolic protection device, SENTINEL, with TAVR versus unprotected TAVR. With a reduction in the primary endpoint of overall stroke -- while the reduction in the primary endpoint of overall stroke did not reach statistical significance, a secondary analysis demonstrated a clinically meaningful 63% relative risk reduction in severe disabling stroke.

隨著我們的 ACURATE neo2 TAVR 平台在歐洲的持續發展，我們的結構性心臟瓣膜特許經營權在第三季度再次增長了兩位數。此外，PROTECTED TAVR 試驗的結果在 TCT 上作為最新的突破者提出。回想一下，PROTECTED TAVR 試驗研究了我們的腦栓塞保護裝置 SENTINEL，使用 TAVR 與未保護的 TAVR。隨著總體卒中主要終點的降低——雖然總體卒中主要終點的降低未達到統計學意義，但二次分析表明，嚴重致殘性卒中的相對風險降低了 63%，具有臨床意義。

Turning to WATCHMAN. Organic sales grew 26% in third quarter. Global growth continues to be very strong, further supported by the U.S. FDA approval of an expanded label to include DAPT, giving physicians and patients choice of DAPT or OAC in the first 45 days post-implant.

轉向守望者。第三季度有機銷售額增長了 26%。全球增長繼續非常強勁，這進一步得到了美國 FDA 批准擴大標籤以包括 DAPT 的支持，使醫生和患者在植入後的前 45 天內可以選擇 DAPT 或 OAC。

We continue to focus on innovation in this space with a TruSteer, which is our new steerable sheath. And we also highlighted our next-generation FLX device, WATCHMAN FLX Pro, at our TCT investor event in September. We expect FLX Pro to build on our second-generation FLX with additional sizes and a device coating designed to enhance healing.

我們繼續通過 TruSteer 專注於該領域的創新，這是我們新的可轉向護套。我們還在 9 月的 TCT 投資者活動中重點介紹了我們的下一代 FLX 設備 WATCHMAN FLX Pro。我們希望 FLX Pro 以我們的第二代 FLX 為基礎，具有更多尺寸和旨在增強癒合的設備塗層。

In Cardiac Rhythm Management, organic sales grew 7% versus prior year. We had another strong quarter of performance as we continue to focus on lifetime patient management, from diagnostics to implant, with our broad portfolio. Within core CRM, our low-voltage franchise grew mid-single digits and high-voltage grew low single digits. Our diagnostics franchise continues to perform very well. We're pleased to have received CE Mark for our implantable cardiac monitor, LUX-Dx, and we have commenced our commercial launch.

在心律管理方面，有機銷售額比去年增長了 7%。由於我們繼續專注於從診斷到植入的終生患者管理，以及我們廣泛的產品組合，我們又取得了強勁的季度業績。在核心 CRM 中，我們的低壓專營權增長了中個位數，而高壓業務增長了低個位數。我們的診斷專營權繼續表現良好。我們很高興我們的植入式心臟監護儀 LUX-Dx 獲得了 CE 標誌，並且我們已經開始了我們的商業發布。

Electrophysiology sales grew 26% on an organic basis and 83% on an operational basis. We continue to see strength in our comprehensive international portfolio, which grew 45% organically. And this includes 2 months of contribution from FARAPULSE. Physician demand for POLARx in Japan and FARAPULSE and POLARx in Europe remains very strong, and we continue to see increased utilization at existing centers, while we are expanding into new accounts. In addition, we're pleased to have launched FARAPULSE in Australia and Singapore under special access, and we anticipate approval in '23.

電生理學銷售額有機增長 26%，運營增長 83%。我們繼續看到我們全面的國際投資組合的實力，有機增長了 45%。這包括 FARAPULSE 2 個月的貢獻。日本的醫生對 POLARx 以及歐洲的 FARAPULSE 和 POLARx 的需求仍然非常強勁，我們繼續看到現有中心的利用率增加，同時我們正在擴展到新的客戶。此外，我們很高興在澳大利亞和新加坡推出 FARAPULSE 並獲得特殊許可，我們預計將在 23 年獲得批准。

The Baylis integration continues to go well with the differentiated transseptal access portfolio growing double digits in the quarter and remains on track to achieve our full year expectations.

Baylis 的整合繼續順利進行，差異化的跨隔膜通路組合在本季度增長了兩位數，並有望實現我們的全年預期。

In Peripheral Interventions, organic sales grew 12% with broad growth across all major franchises and regions. In arterial, our differentiated drug-eluting portfolio grew double digits in the quarter and we received FDA approval for a line extension of Eluvia and commenced launch of the longest length of drug eluting stent for peripheral arterial disease in the U.S.

在 Peripheral Interventions 中，有機銷售額增長了 12%，所有主要特許經營權和地區均實現了廣泛增長。在動脈領域，我們的差異化藥物洗脫產品組合在本季度實現了兩位數增長，我們獲得了 FDA 對 Eluvia 產品線擴展的批准，並開始在美國推出最長的外周動脈疾病藥物洗脫支架。

The Interventional Oncology business had another very strong quarter with great growth and continued strength in our cancer therapies, [ICEex] and TheraSphere. We're pleased to have closed on the acquisition of Obsidio and the gel embolic material technology. Obsidio is the first gel embolic with an indication for the peripheral vasculature and a complementary addition to our portfolio. We look forward to launching this technology within the U.S. in 2023.

介入腫瘤學業務在我們的癌症治療 [ICEex] 和 TheraSphere 方面取得了巨大的增長和持續的強勁增長。我們很高興完成對 Obsidio 和凝膠栓塞材料技術的收購。 Obsidio 是第一個具有外周血管適應症的凝膠栓塞劑，是我們產品組合的補充。我們期待 2023 年在美國推出這項技術。

In alignment with our overall commitment to progress our environment, social and governance efforts, the PI division announced collaboration with a health care data platform, Truveta, aiming to provide insights to help better address health care disparities within various PI disease states.

根據我們對推進環境、社會和治理工作的總體承諾，PI 部門宣布與醫療保健數據平台 Truveta 合作，旨在提供見解以幫助更好地解決各種 PI 疾病狀態中的醫療保健差異。

We remain committed to driving sustainable innovation to Boston Scientific. And despite the persistent macroeconomic pressures, we continue to invest for the long term in R&D, execute strategic tuck-in M&A with a focus on improving patient outcomes today and into the future.

我們仍然致力於推動波士頓科學公司的可持續創新。儘管宏觀經濟壓力持續存在，我們仍將繼續長期投資於研發，執行戰略性併購，重點是改善當今和未來的患者治療效果。

We're also excited about the opportunities ahead and remain focused on our long-term financial goals: Continuing to grow sales faster than the markets, operating margin expansion, double-digit adjusted EPS growth and strong adjusted free cash flow generation.

我們也對未來的機遇感到興奮，並繼續專注於我們的長期財務目標：繼續以快於市場的速度增長銷售額、擴大營業利潤率、兩位數的調整後每股收益增長和強勁的調整後自由現金流產生。

Before I turn it over to Dan, I do want to take a moment to share that our Chief Medical Officer, Dr. Ian Meredith, will be retiring in April of 2023. We're extremely grateful for his strong contributions, particularly his dedication to patients, clinical science and meaningful innovation. And his great sense of humor.

在我把它交給 Dan 之前，我想花點時間分享一下我們的首席醫療官 Ian Meredith 博士將於 2023 年 4 月退休。我們非常感謝他的巨大貢獻，特別是他對患者、臨床科學和有意義的創新。還有他的幽默感。

With that, I'll now turn things over to Dan to review our financial performance in more detail.

有了這個，我現在將把事情交給丹，以更詳細地審查我們的財務業績。

Thanks, Mike. Third quarter consolidated revenue of $3.170 billion million represents 8.1% reported revenue growth versus third quarter 2021 and reflects a $162 million headwind from foreign exchange, higher than our expectations due to the continued strength of the U.S. dollar. Excluding this 550 basis point headwind from foreign exchange, operational revenue growth was 13.7% in the quarter.

謝謝，邁克。第三季度合併收入為 31.7 億美元，較 2021 年第三季度報告的收入增長 8.1%，反映出來自外彙的 1.62 億美元逆風，由於美元持續走強，高於我們的預期。排除來自外彙的 550 個基點的逆風，本季度營業收入增長 13.7%。

Sales from the acquisitions of FARAPULSE through July, Lumenis through August and Baylis contributed 220 basis points, resulting in 11.5% organic revenue growth, exceeding the high end of our guidance range of 8% to 10% growth versus 2021.

收購 FARAPULSE 至 7 月、收購 Lumenis 至 8 月和 Baylis 的銷售額貢獻了 220 個基點，導致有機收入增長 11.5%，超過了我們與 2021 年相比增長 8% 至 10% 的指導範圍的高端。

Continued foreign exchange headwinds and slightly higher spend on R&D investment across the portfolio largely offset our top line outperformance, resulting in Q3 adjusted earnings per share of $0.43, achieving the low end of our guidance range, representing 6.3% growth versus 2021.

持續的外匯逆風和整個投資組合的研發投資支出略有增加在很大程度上抵消了我們的營收表現，導致第三季度調整後每股收益為 0.43 美元，達到我們指導範圍的低端，與 2021 年相比增長 6.3%。

Adjusted gross margin for the third quarter was 70.7%, in line with our expectations. The macroeconomic environment continues to be challenging, particularly related to inflationary pressures and availability of materials, which have largely offset a slight improvement in freight costs.

第三季度調整後的毛利率為 70.7%，符合我們的預期。宏觀經濟環境繼續充滿挑戰，特別是與通脹壓力和材料供應有關，這在很大程度上抵消了運費成本的小幅改善。

For full year 2022, we continue to expect adjusted gross margin to be slightly below 70.8%, which includes $375 million in macroeconomic headwinds versus 2019. These headwinds are predominantly from increased freight costs and unfavorable manufacturing variances, primarily related to direct material cost and availability with a smaller portion attributable to increased labor costs. Recall, unfavorable manufacturing variances are recognized over approximately 6 months, in line with our inventory turns.

對於 2022 年全年，我們繼續預計調整後的毛利率將略低於 70.8%，其中包括與 2019 年相比 3.75 億美元的宏觀經濟逆風。這些逆風主要來自貨運成本增加和不利的製造差異，主要與直接材料成本和可用性有關較小的部分歸因於勞動力成本的增加。回想一下，不利的製造差異在大約 6 個月內被確認，與我們的庫存周轉一致。

Third quarter adjusted operating margin was 25.5%, slightly lower than our expectations. We continue to focus on our global goal of operating margin expansion, but believe it is prudent to update our operating margin target to allow for the flexibility to weigh near-term spend discipline with investments to continue to fuel top line growth. We now expect full year adjusted operating margin to be approximately 26%.

第三季度調整後的營業利潤率為 25.5%，略低於我們的預期。我們繼續專注於擴大營業利潤率的全球目標，但認為更新我們的營業利潤率目標是謹慎的做法，以便靈活地權衡近期支出紀律與投資，以繼續推動收入增長。我們現在預計全年調整後的營業利潤率約為 26%。

Onetime charges within the quarter's results included a minor write-off related to the discontinuation of our SAVAL program. In addition, we recognized a GAAP charge attributable to an intangible asset impairment of $125 million primarily related to Vertiflex as the business continues to face reimbursement challenges impacting the revenue outlook for the product. On a GAAP basis, the third quarter operating margin was 11.3%.

本季度業績中的一次性費用包括與我們的 SAVAL 計劃終止有關的小額註銷。此外，由於業務繼續面臨影響產品收入前景的報銷挑戰，我們確認了主要與 Vertiflex 相關的 1.25 億美元無形資產減值導致的 GAAP 費用。按公認會計原則計算，第三季度營業利潤率為 11.3%。

Moving to below the line. Adjusted interest and other expense totaled $91 million in Q3, higher than our expectations driven in part by FX losses from certain unhedged currencies. Our tax rate for the third quarter was 11.9% on an adjusted basis, including discrete tax items and the benefit from stock compensation accounting. Excluding these items, our operational tax rate was 14%, in line with expectations. We ended Q3 with 1.440 billion fully diluted weighted average shares outstanding.

移動到線下。第三季度調整後的利息和其他費用總計 9100 萬美元，高於我們的預期，部分原因是某些未對沖貨幣造成的外匯損失。我們第三季度的稅率在調整後為 11.9%，包括離散稅項和股票補償會計的收益。剔除這些項目，我們的營業稅率為 14%，符合預期。我們在第三季度結束時擁有 14.4 億股完全稀釋的加權平均流通股。

Adjusted free cash flow for the quarter was $626 million; and free cash flow, $320 million, with $470 million from operating activities, less $150 million net capital expenditures. We now expect our full year 2022 adjusted free cash flow to be approximately $2 billion.

本季度調整後的自由現金流為 6.26 億美元；自由現金流為 3.2 億美元，其中 4.7 億美元來自運營活動，減去 1.5 億美元的淨資本支出。我們現在預計 2022 年全年調整後的自由現金流約為 20 億美元。

Our total legal reserve as of September 30 was $304 million, a decrease of $210 million versus June 30, primarily related to mesh and certain IP litigation payments.

截至 9 月 30 日，我們的總法律準備金為 3.04 億美元，比 6 月 30 日減少 2.1 億美元，主要與網狀網絡和某些知識產權訴訟付款有關。

As of September 30, 2022, we had cash on hand of $338 million. Our top priority for capital allocation remains high-quality tuck-in M&A, and we'll continue to assess opportunities in conjunction with our financial goals. As of September 30, our leverage was 2.5x, and we now expect year-end leverage to be at or slightly below 2.5x.

截至 2022 年 9 月 30 日，我們手頭有 3.38 億美元的現金。我們資本配置的首要任務仍然是高質量的併購，我們將繼續結合我們的財務目標評估機會。截至 9 月 30 日，我們的槓桿率為 2.5 倍，我們現在預計年終槓桿率將達到或略低於 2.5 倍。

I'll now walk through guidance for Q4 and the full year 2022. We expect full year 2022 operational revenue growth to be approximately 11.5% versus 2021, which excludes an approximate 500 basis point headwind from foreign exchange based on current rates, 100 basis points higher than our previous expectations. Excluding a 250 basis point contribution from the acquisitions of Preventice, FARAPULSE, Lumenis and Baylis, and $13 million of pre-divestiture Specialty Pharmaceutical sales in 2021, we now expect full year 2022 organic revenue growth to be approximately 9% versus 2021, reflecting our strong Q4 performance and confidence in continued consistent procedural growth.

我現在將介紹第四季度和 2022 年全年的指導。我們預計 2022 年全年營業收入將比 2021 年增長約 11.5%，其中不包括基於當前匯率的約 500 個基點的外匯逆風，100 個基點高於我們之前的預期。不包括收購 Preventice、FARAPULSE、Lumenis 和 Baylis 帶來的 250 個基點貢獻，以及 2021 年剝離前的 1300 萬美元特種藥品銷售額，我們現在預計 2022 年全年有機收入增長將比 2021 年增長約 9%，這反映了我們的強勁的第四季度業績和對持續持續增長的信心。

We expect fourth quarter 2022 operational revenue growth to be in a range of 8.5% to 10.5% versus 2021, which excludes an approximate 650 basis point headwind from foreign exchange based on current rates. Excluding a 150 basis point contribution from the acquisition of Baylis, we expect fourth quarter 2022 organic revenue growth to be in a range of 7% to 9%. We continue to expect our full year 2022 adjusted below-the-line expenses to be approximately $350 million.

我們預計與 2021 年相比，2022 年第四季度的營業收入增長將在 8.5% 至 10.5% 的範圍內，其中不包括基於當前匯率的約 650 個基點的外匯逆風。排除收購 Baylis 帶來的 150 個基點貢獻，我們預計 2022 年第四季度的有機收入增長將在 7% 至 9% 之間。我們繼續預計我們 2022 年全年調整後的線下費用約為 3.5 億美元。

Full year 2022 operational tax rate expectations remain unchanged at approximately 14%, with an adjusted tax rate of approximately 13%, including the benefit of the accounting standard for stock compensation and discrete tax items recognized year-to-date. Our tax rate expectations reflect current legislation, including a provision on the treatment of R&D expenditures. We continue to believe there's bipartisan support to reverse this provision. And if such legislation were to be enacted, we would expect our full year tax rate to revert to its historical range of approximately 11% operational and 10% adjusted.

2022 年全年營業稅率預期保持不變，約為 14%，調整後的稅率約為 13%，包括股票薪酬會計準則和年初至今確認的離散稅項的好處。我們的稅率預期反映了當前的立法，包括關於處理研發支出的規定。我們仍然相信有兩黨支持推翻這一規定。如果要頒布這樣的立法，我們預計我們的全年稅率將恢復到其歷史範圍，即約 11% 的運營和 10% 的調整。

We expect a fully diluted weighted average share count of approximately 1.443 billion shares for Q4 2022 and 1.440 billion shares for the full year 2022.

我們預計 2022 年第四季度和 2022 年全年的完全攤薄加權平均股數約為 14.43 億股和 14.40 億股。

Our long-term hedging strategy continues to be effective at minimizing FX impact on EPS, and we are largely hedged through 2023. At current rates, we now anticipate FX headwinds on our full year 2022 adjusted earnings per share of $0.06, which is $0.03 unfavorable versus previous expectations, due to the continued strengthening of the U.S. dollar. As a result, we are updating our full year adjusted earnings per share range to $1.71 to $1.74, representing 5% to 7% growth versus 2021. We expect fourth quarter adjusted earnings per share to be in a range of $0.45 to $0.48.

我們的長期對沖策略在最大限度地減少外匯對每股收益的影響方面繼續有效，我們在 2023 年之前基本上都在對沖。按照目前的匯率，我們現在預計 2022 年全年調整後每股收益 0.06 美元的外匯逆風，這是不利的 0.03 美元與之前的預期相比，由於美元持續走強。因此，我們將全年調整後每股收益範圍更新至 1.71 美元至 1.74 美元，與 2021 年相比增長 5% 至 7%。我們預計第四季度調整後每股收益將在 0.45 美元至 0.48 美元之間。

One quick housekeeping item before I turn it back over to Lauren. We continue to expect full year 2022 preferred stock dividend expense of approximately $55 million related to our May 2020 Mandatory Convertible Preferred Stock offering using the if-converted method. These shares will mature on June 1, 2023. At which point, the dividend expense will retire, and our share count will increase based on our share price at the time of conversion. In each of the conversion scenarios, the resulting impact to EPS should be immaterial.

在我把它還給勞倫之前，一件快速的家務用品。我們繼續預計 2022 年全年優先股股息費用約為 5500 萬美元，與我們使用 if-converted 方法在 2020 年 5 月發行的強制性可轉換優先股有關。這些股票將於 2023 年 6 月 1 日到期。屆時，股息費用將退休，我們的股票數量將根據轉換時的股價增加。在每種轉換情景中，對每股收益的影響都應該是微不足道的。

For more information, please check our Investor Relations website for Q3 2022 financial and operational highlights, which outlines more details on Q3 results and the MCPS share conversion.

如需更多信息，請查看我們的投資者關係網站，了解 2022 年第三季度財務和運營亮點，其中概述了第三季度業績和 MCPS 股票轉換的更多細節。

In closing, I'm proud of the results we've achieved year-to-date with continued revenue momentum. And despite a challenging macroeconomic environment, we remain focused on operating margin expansion, balanced with investment in our innovative portfolio, to drive continued above-market top line growth.

最後，我為我們今年迄今取得的成果以及持續的收入勢頭感到自豪。儘管宏觀經濟環境充滿挑戰，但我們仍專注於擴大營業利潤率，並與對我們創新投資組合的投資保持平衡，以推動持續高於市場的收入增長。

And with that, I'll turn it back to Lauren, who will moderate the Q&A.

有了這個，我將把它轉回給 Lauren，他將主持問答環節。

Thank you, Dan. Andrew, let's open it up to questions for the next 35 minutes or so. (Operator Instructions). Andrew, please go ahead.

謝謝你，丹。安德魯，讓我們在接下來的 35 分鐘左右開放問題。 （操作員說明）。安德魯，請繼續。

(Operator Instructions) First question comes from Robbie Marcus with JPMorgan.

（操作員說明）第一個問題來自摩根大通的 Robbie Marcus。

Congrats on a great top line quarter. I'll also add congratulations to Dr. Meredith on a very well-deserved retirement.

祝賀一個偉大的頂線季度。我還要祝賀 Meredith 博士當之無愧的退休。

Maybe for my question, it really was a strong top line, double digits organic. Fourth quarter continues to look good in guidance. I think the one area where we've seen a little pressure is on margin. So Dan, I was hoping you might be able to give us an early look into next year. How elevated is the spending? There's a lot of moving pieces with OpEx and currency and the share count. Do you think The Street's generally in a decent spot for next year with returning to more normalized margin expansion? Or do you think it's still going to be a pressured year in 2023?

也許對於我的問題，這確實是一個強大的頂線，兩位數的有機。第四季度的指引繼續看好。我認為我們看到一點壓力的一個領域是利潤率。所以丹，我希望你能夠讓我們提前了解明年。支出有多高？運營支出、貨幣和份額有很多變化。您是否認為華爾街明年總體上處於一個不錯的位置，並恢復到更正常的利潤率擴張？還是您認為 2023 年仍將是充滿壓力的一年？

Sure, Robbie. I think obviously, early to comment on 2023 specifically. But I think I can probably give you some commentary that would be helpful.

當然，羅比。我認為很明顯，早點對 2023 年做出具體評論。但我想我可能會給你一些有用的評論。

First, you mentioned share count. That shouldn't really be a driving factor because I mentioned on the conversion of the MCPS, that, that shouldn't really impact next year's EPS once converted.

首先，您提到了股票數量。這不應該是一個真正的驅動因素，因為我提到了 MCPS 的轉換，一旦轉換，那不應該真正影響明年的每股收益。

Let me look at Q3 first, though. If you look at EPS for the quarter, given the reported revenue at the high end of the range, it's probably reasonable to expect that we would have been at the high end of the EPS range, which was $0.43 to $0.45. We achieved $0.43, which is $0.02 lower than the $0.45. $0.01 of that is from the incremental FX headwind and $0.01 is from lower operating income percentage versus expectations in the quarter.

不過，讓我先看看第三季度。如果您查看本季度的每股收益，鑑於報告的收入處於該範圍的高端，我們可以合理地預期我們將處於每股收益範圍的高端，即 0.43 美元至 0.45 美元。我們實現了 0.43 美元，比 0.45 美元低 0.02 美元。其中 0.01 美元來自增加的外匯逆風，0.01 美元來自本季度營業收入百分比低於預期。

I think -- the FX impact, I think, is well understood given the strengthening of the U.S. dollar, so not a lot of additional commentary there. Relative to our operating income percentage, the goal is to be 26% for the full year. And this involves balancing certain initiatives to reduce expenses in the short term to offset the supply chain and inflation headwinds, while at the same time, continuing to fuel our top line, which has been performing very well.

我認為 - 我認為，鑑於美元走強，外匯影響是很容易理解的，因此沒有太多額外的評論。相對於我們的營業收入百分比，全年目標是 26%。這涉及平衡某些舉措以在短期內減少開支以抵消供應鍊和通貨膨脹的不利因素，同時繼續推動我們一直表現良好的收入。

If you look at the P&L components of a 26% adjusted margin scenario in 2022, it would likely have gross margin higher than 2021, SG&A lower than 2021 and R&D slightly higher than 2021. And we think this is appropriate. And keep in mind, as Mike said, this would be 70 basis points higher than the 2021 adjusted operating income margin full year of 25.3%; and in line with the 2021 second half; and importantly, in line with 2019 full year, while absorbing $375 million of supply chain and inflation headwinds compared to 2019. So I feel real -- very good about how we're balancing that and looking at that 26% as a very successful number for the year.

如果你看一下 2022 年 26% 調整後利潤率情景的損益部分，它的毛利率可能高於 2021 年，SG&A 低於 2021 年，研發略高於 2021 年。我們認為這是合適的。請記住，正如邁克所說，這將比 2021 年調整後全年 25.3% 的營業利潤率高出 70 個基點；並符合2021年下半年；重要的是，與 2019 年全年一致，同時與 2019 年相比，吸收了 3.75 億美元的供應鍊和通脹逆風。所以我感覺很真實——我們如何平衡這一點非常好，並將 26% 視為一個非常成功的數字一年。

Specific to 2023. Again, our goal is always to continue to increase operating margin. Long-standing goal of doing that 50 basis points per year. If you look at the 25.3% last year, we'll be 70 basis points, as I said, advanced on that in '22 if we hit that 26%, and then even with where we were in 2019 and the second half.

具體到 2023 年。同樣，我們的目標始終是繼續提高營業利潤率。每年50個基點的長期目標。如果你看看去年的 25.3%，我們將達到 70 個基點，正如我所說，如果我們達到 26%，那麼我們將在 22 年提高 70 個基點，甚至在 2019 年和下半年的情況下也是如此。

So more to come as we evolve and deliver guidance, likely in that February timeframe. But I feel good where we are in '22 and look forward to continuing the journey in '23 and beyond.

隨著我們的發展和提供指導，可能會在 2 月份的時間範圍內推出更多內容。但我對我們在 22 年所處的位置感覺良好，並期待在 23 年及以後繼續這段旅程。

The next question comes from Larry Biegelsen with Wells Fargo.

下一個問題來自富國銀行的拉里·比格爾森。

I just wanted to ask about Neuromodulation. Mike, could you talk a little bit about -- more about the reimbursement challenges there? What channels are you seeing that in?

我只是想問一下神經調節。邁克，你能談談 - 更多關於那裡的報銷挑戰嗎？你在哪些渠道看到的？

And it seems like all your businesses are consistently growing around the corporate growth rate except Neuromodulation. So what's the plan to accelerate the growth in that business?

似乎您所有的業務都在圍繞公司增長率持續增長，除了神經調節。那麼加速該業務增長的計劃是什麼？

And let me just also extend my congratulations to Dr. Meredith. And I wholeheartedly agree with your comments earlier, especially about his sense of humor.

讓我也向 Meredith 博士表示祝賀。我完全同意你之前的評論，尤其是關於他的幽默感。

Larry, yes, we're quite proud of the performance of nearly every business grew double digits and faster than the peer group, and every region as well. You saw the growth in Europe and China and all over. So we're quite proud of the results in the quarter and really through the year.

拉里，是的，我們為幾乎每家企業的業績都以兩位數的速度增長並且比同行以及每個地區都快，我們對此感到非常自豪。你看到了歐洲和中國以及世界各地的增長。因此，我們對本季度以及全年的結果感到非常自豪。

Neuromod, they're really broken down in 2 pieces. The deep brain stimulation franchise is doing extremely well, growing strong double digits, U.S., Europe, and a nice pipeline. And we're not seeing really some of the macro headwinds in the DBS business.

Neuromod，它們真的被分解成兩部分。深部腦刺激系列表現非常好，增長強勁的兩位數，美國，歐洲和一個不錯的管道。而且我們並沒有真正看到星展銀行業務中的一些宏觀逆風。

On the spinal cord stimulation business, as you know, this market has been tough to call, really over the past few years during the pandemic, and now as we're essentially hopefully getting out of the pandemic. The market's, we think, in the low single digits to potentially mid-single-digit range now. So it has come down a bit in terms of the overall market growth rate, we believe.

如您所知，在脊髓刺激業務方面，這個市場一直很難被調用，實際上是在過去幾年大流行期間，而現在我們基本上有望擺脫大流行。我們認為，市場現在處於低個位數到潛在的中個位數範圍內。因此，我們認為，就整體市場增長率而言，它已經有所下降。

What's hurting the market, not necessarily Boston Scientific, as you've seen some competitive results already and you've seen this trend throughout the year, has been in the spinal cord stimulation market in the U.S. And we're seeing more preauthorization denials in the U.S.

損害市場的是什麼，不一定是波士頓科學，因為您已經看到了一些有競爭力的結果，並且您全年都看到了這種趨勢，一直在美國的脊髓刺激市場。我們看到更多的預授權被拒絕美國。

We are seeing strong patient funnels. So our team is essentially really focused on building additional capabilities to help our physician customers manage those preauthorization denials. These patients need the products. The products obviously work. I think it's more of an industry challenge right now. And we're working with them to streamline that authorization process to get patients through the funnel and physician to get paid.

我們看到了強大的患者漏斗。因此，我們的團隊基本上真正專注於建立額外的能力，以幫助我們的醫生客戶管理這些預授權拒絕。這些患者需要這些產品。這些產品顯然有效。我認為現在這更像是一個行業挑戰。我們正在與他們合作，簡化授權流程，讓患者通過漏斗，讓醫生獲得報酬。

So we do anticipate that headwind will persist in fourth quarter. Hopefully, it will get better in 2023. Us, like our competitors, will have easy comps in 2023 based on this, so that helps mathematically. But fundamentally, we need to improve the -- help our patients and customers with this preauthorization hiccups and some of the capabilities we're building to the system with that. But I think it's more a class issue right now than a Boston Scientific issue.

因此，我們確實預計逆風將在第四季度持續存在。希望它在 2023 年會變得更好。我們和我們的競爭對手一樣，在此基礎上將在 2023 年輕鬆進行比賽，因此這在數學上有所幫助。但從根本上說，我們需要改進——幫助我們的患者和客戶解決預授權問題以及我們正在為系統構建的一些功能。但我認為它現在更像是一個階級問題，而不是波士頓科學的問題。

The next question comes from Joanne Wuensch with Citi.

下一個問題來自花旗的 Joanne Wuensch。

Sorry, can I -- can we spend a little bit of time on WATCHMAN franchise? You've had, over the last 12 months, increased competition but an improved label and sort of broader geographic reach. Can you pick apart how those segments are going or how those headwinds, and maybe not headwinds, are impacting the franchise?

抱歉，我可以——我們可以花一點時間在守望者專營權上嗎？在過去的 12 個月裡，您的競爭加劇了，但標籤得到了改進，地理覆蓋範圍更廣了。您能否區分這些細分市場的進展情況，或者這些逆風（也許不是逆風）如何影響特許經營權？

Sure. The WATCHMAN business had a terrific quarter. It grew 26%. The bulk of that growth coming from the U.S. We have launched recently in Japan, albeit a bit slower given the COVID situation there and the need for more proctoring, but that should have a bigger impact for us in '23.

當然。守望者業務有一個了不起的季度。它增長了 26%。大部分增長來自美國。我們最近在日本推出，儘管考慮到那裡的 COVID 情況和需要更多監考，但速度會慢一些，但這應該對 23 年的我們產生更大的影響。

Similar results in China, I would say same commentary. A bit slower out of the gate given some of the COVID restrictions, but should get better in '23. We've also continued to gain share in Europe, which I think is important. But by far, the most important market is the U.S., and the team there has done an excellent job.

在中國也有類似的結果，我會說同樣的評論。考慮到一些 COVID 限制，出門速度有點慢，但在 23 年應該會變得更好。我們還繼續在歐洲獲得份額，我認為這很重要。但到目前為止，最重要的市場是美國，那裡的團隊做得很好。

It's really a comment similar to previous calls. You did call out the DAPT label. That did have some additional momentum for us in third quarter as some physicians kind of converted back to WATCHMAN FLX now that we've had that label. And really, it's the consistent ease of use, the safety benefits and the support that the implanting cardiologist or EP is receiving from the referrer. The referring community is getting more and more confident in WATCHMAN, in particular, each quarter.

這真的是一個類似於以前的電話的評論。你確實提到了 DAPT 標籤。這確實為我們在第三季度帶來了一些額外的動力，因為一些醫生在我們擁有該標籤後轉回了 WATCHMAN FLX。確實，植入心髒病專家或 EP 從推薦人那裡獲得了始終如一的易用性、安全優勢和支持。推薦社區對 WATCHMAN 越來越有信心，尤其是每個季度。

And so we expect the market to continue to be quite healthy. We're calling it roughly 30% growth. We're investing in the clinical trials that you're aware of, with OPTION and CHAMPION, to further widen the market opportunity for it. And we have a very strong pipeline of new products coming behind what is already differentiated from our competitor WATCHMAN FLX product. So we think we're in a really good position here, and we're going to continue to grow the market and invest to have this be one of our top growth drivers.

因此，我們預計市場將繼續保持相當健康。我們稱之為大約 30% 的增長。我們正在通過 OPTION 和 CHAMPION 對您所了解的臨床試驗進行投資，以進一步擴大其市場機會。我們擁有非常強大的新產品管道，這些產品已經與我們的競爭對手 WATCHMAN FLX 產品區分開來。因此，我們認為我們在這里處於非常有利的位置，我們將繼續發展市場並進行投資，以使其成為我們的主要增長動力之一。

The next question comes from Vijay Kumar with Evercore.

下一個問題來自 Evercore 的 Vijay Kumar。

Dan, maybe one for you on the financial side here. I think the 26% operating margin for the year, that would imply Q4, the pretty steep ramp in Q4. Are we thinking about margins the right way in that? And when you think about those margins, what should FX impact be for next year at current rates? Anything to think about? Balance sheet inventories which have been capitalized, that flowing through the P&L for next year, any impact for '22? This year, impact...

丹，也許在財務方面給你一個。我認為今年 26% 的營業利潤率意味著第四季度，即第四季度相當陡峭的增長。我們是否以正確的方式考慮利潤？當您考慮這些利潤率時，以當前匯率計算，明年的外匯影響應該是什麼？有什麼要考慮的嗎？已資本化的資產負債表存貨，流經明年損益表的存貨，對 22 年有何影響？今年影響...

Sure. Relative to -- say that again, Vijay?

當然。相對於——再說一遍，維杰？

I meant the inventory impact for '23, sorry. Not '22.

我的意思是 23 年的庫存影響，抱歉。不是'22。

Yes, right, got that. Specific to Q4, so your math is right, right? We're 25.5% year-to-date adjusted operating margin. So it implies a 27.5% for the fourth quarter to get to the full year 26%. We believe we have the plans in place to do that. There's a bit of a seasonality that helps. If you look back over the past few years, Q4 is usually the highest-margin quarter we have, both gross and operating. So we're looking for that trend to continue here in Q4. So -- but yes, it requires a strong Q4, but we believe we have the plans in place to deliver that.

是的，對，明白了。具體到第四季度，所以你的數學是對的，對吧？年初至今調整後的營業利潤率為 25.5%。因此，這意味著第四季度的 27.5% 達到全年的 26%。我們相信我們已經制定了計劃來做到這一點。有一點季節性有幫助。如果你回顧過去幾年，第四季度通常是我們利潤率最高的季度，無論是毛利潤還是運營利潤。因此，我們正在尋找這種趨勢在第四季度繼續存在。所以 - 但是是的，它需要一個強勁的第四季度，但我們相信我們已經制定了實現這一目標的計劃。

Specific to '23, I probably can be a little bit helpful on that. I think somewhat unique to us in our hedging program, we do hedge out multiple years in that program. So as I mentioned in my commentary, we are largely hedged for 2023. So if rates were to stay where they are today, I think you'd likely see an impact in '23 of pretty similar to what you see this year on earnings per share.

具體到 23 年，我可能會對此有所幫助。我認為我們的對沖計劃對我們來說有些獨特，我們確實在該計劃中對沖多年。因此，正如我在評論中提到的那樣，我們在很大程度上對 2023 年進行了對沖。因此，如果利率保持在今天的水平，我認為您可能會在 23 年看到與您今年對每股收益的影響非常相似分享。

Recall, at the operating margin percentage level, you don't see much benefit from FX. You see that in the gross margin. But then because our -- the majority of our OpEx dollars are dollar-denominated, you lose that in the OpEx section of the P&L. So the operating margin contribution from FX is very minor. So not much to talk about there. But relative to EPS impact, I would say likely similar to what you see this year, assuming rates remain constant.

回想一下，在營業利潤率百分比水平上，您看不到外匯帶來的太多好處。您可以在毛利率中看到這一點。但是因為我們的大部分運營支出都是以美元計價的，所以你會在損益表的運營支出部分失去它。因此，外匯對營業利潤率的貢獻非常小。所以沒有太多可談的。但相對於每股收益的影響，假設利率保持不變，我想說可能與你今年看到的類似。

The next question comes from Travis Steed with Bank of America.

下一個問題來自美國銀行的 Travis Steed。

Also congrats to Ian Meredith. So I might have missed it earlier, but can you remind us again the moving parts on what drove the higher OpEx and the lower op margin guide for 2022 versus 3 months ago? Just as a quick clarification.

也祝賀伊恩梅雷迪思。所以我可能早些時候錯過了它，但你能否再次提醒我們，與 3 個月前相比，是什麼推動了 2022 年更高的運營支出和更低的運營利潤率指南？就像一個快速的澄清。

And then the question I was going to ask was more on the Analyst Day last year, you were committed to a double-digit EPS growth CAGR. This year, you're closer to 7%. Is that double-digit EPS CAGR still good? And can the starting point for 2023 still be in that double-digit range, given the macro pressures that we're in?

然後我要問的問題更多是在去年的分析師日，你致力於實現兩位數的每股收益複合年增長率。今年，你接近 7%。兩位數的每股收益複合年增長率仍然不錯嗎？考慮到我們所處的宏觀壓力，2023 年的起點還能保持在兩位數的範圍內嗎？

Yes, on the double-digit earnings per share, that's always been our growth goal, and we've achieved that many years. The issue this year is a change in tax legislation that was -- that went into effect in January. And that is about $0.06 overall for the year. So if that were the old legislation, we'd be solidly double digits.

是的，就每股兩位數的收益而言，這一直是我們的增長目標，而且我們已經實現了這麼多年。今年的問題是稅收立法的變化，該立法於一月份生效。這一年的總額約為 0.06 美元。所以如果那是舊的立法，我們肯定是兩位數。

R&D amort, yes.

研發攤銷，是的。

It's a provision on the amortization of R&D within tax. And so that's really the kind of the stick in the spokes of getting to double digits this year. Double digit remains our goal going forward, as we talked about at Investor Day.

這是一項關於稅收內R&D攤銷的規定。所以這確實是今年達到兩位數的關鍵。正如我們在投資者日所談到的，兩位數仍然是我們前進的目標。

And then your first question was?

然後你的第一個問題是？

I'll just comment. There's a lot of focus on, with AdvaMed Society and others, on legislate -- on advocating for that R&D amortization to reverse. So that is a one-timer that will annualize in '23. And if you neutralize that and some of the FX, we're strong double digits for the year.

我只會評論。與 AdvaMed Society 和其他人一起，有很多重點關注立法 - 倡導扭轉研發攤銷。所以這是一個一次性的，將在 23 年年化。如果你抵消了這一點和一些外匯，我們今年的強勁兩位數。

Exactly.

確切地。

That's helpful. And if you could just remind us, the moving parts on the 2022 margin guide. Exactly what the higher OpEx and what drove the change in op margin again. I may have missed that earlier.

這很有幫助。如果你能提醒我們，2022 年保證金指南上的活動部分。究竟是什麼更高的運營支出以及什麼再次推動了運營利潤率的變化。我之前可能錯過了。

Yes, it's really just a balance within the P&L. So if you think of where we are versus 2021, you'll see higher gross margin, you'll see lower SG&A and you'll see slightly higher R&D. So we're balancing the P&L to try and offset the $375 million of headwinds that we have versus 2019. And just maintaining the appropriate level of spend in that R&D line to continue to fuel the top line. So that's really the only tweak within there. So making sure that we fuel the top line while still trying to offset the supply chain and inflationary headwinds.

是的，這實際上只是損益表中的平衡。因此，如果你想想我們與 2021 年相比的情況，你會看到更高的毛利率，你會看到更低的 SG&A，你會看到略高的研發。因此，我們正在平衡損益表，以試圖抵消我們與 2019 年相比所面臨的 3.75 億美元的不利因素。並且只是保持研發線的適當支出水平，以繼續推動收入增長。所以這真的是那裡唯一的調整。因此，確保我們在努力抵消供應鍊和通脹逆風的同時為收入提供燃料。

The next question comes from Cecilia Furlong with Morgan Stanley.

下一個問題來自摩根士丹利的 Cecilia Furlong。

Just wanted to ask a bit more color on what you saw exiting September versus July and August across your portfolio. And then looking at the 4Q guide, if you could just walk through kind of expectations, either U.S., o U.S., what you're looking at for China. And then just expected either seasonality or any impact from deductibles. Anything you would call out specifically that you incorporated in the 4Q guide.

只是想對您在投資組合中看到的 9 月與 7 月和 8 月的退出情況進行更多了解。然後看看第 4 季度指南，如果你能通過某種期望，無論是美國，還是美國，你對中國的期望。然後只是預期季節性或免賠額的任何影響。您在 4Q 指南中特別提到的任何內容。

Yes. I mean, I don't exactly see -- I don't think we're going to get into the specifics of the quarter. I mean, we're -- I think the revenue results stand on their own. We're super proud of the 11.5% organic growth in the quarter. So I think that speaks for itself.

是的。我的意思是，我不完全明白 - 我認為我們不會進入本季度的細節。我的意思是，我們 - 我認為收入結果是獨立的。我們對本季度 11.5% 的有機增長感到非常自豪。所以我認為這不言自明。

Relative to Q4, obviously, we're giving guidance today. We know where we are through October the -- through -- (inaudible) where we are in October. And Neuromod, as Mike said, Neuromod is probably a bit challenged in Q4 versus what we might have expected 90 days ago. But the rest of the business has tremendous momentum. And again, super proud of the 11.5% that we delivered in Q3, again, with most of those businesses in double digits.

顯然，相對於第四季度，我們今天給出了指導。我們知道我們在 10 月份所處的位置 - 通過 - （聽不清）我們在 10 月份所處的位置。正如邁克所說，Neuromod 與我們 90 天前的預期相比，在第四季度可能會遇到一些挑戰。但其他業務發展勢頭強勁。再次為我們在第三季度交付的 11.5% 感到非常自豪，其中大多數業務都是兩位數。

Yes. You asked about the regions. You saw the U.S. performance in third quarter and for the full year is quite strong, but also a particular strength in Europe and Asia Pac. And our China business grew over 30% in the quarter. It's done extremely well this year based on the diversification of the portfolio and the product launches and really the innovation of the team in China. And also shout out to the European team. In a very mature market, continues to grow double digits in the kind of Western, more established markets and very strong double digits in the emerging markets there.

是的。你問了地區。你看到美國在第三季度和全年的表現相當強勁，但在歐洲和亞太地區也特別強。我們的中國業務在本季度增長了 30% 以上。基於產品組合的多樣化和產品的推出以及中國團隊的創新，今年做得非常好。還向歐洲隊大喊大叫。在一個非常成熟的市場中，在西方更成熟的市場中繼續以兩位數的速度增長，在新興市場中的兩位數非常強勁。

So you're seeing really balanced growth across each region throughout the year. And many of those products, as I mentioned in the script, in Europe, particularly in EP, we're working on clinical trials to get these products through and improved in the U.S.

因此，您會看到全年每個地區的增長非常平衡。正如我在劇本中提到的那樣，其中許多產品在歐洲，特別是在歐洲，我們正在開展臨床試驗，以使這些產品在美國通過並得到改進。

The next question comes from Rick Wise with Stifel.

下一個問題來自 Rick Wise 和 Stifel。

Mike, Dan, 2 questions. Maybe just on the recovery, just one large picture and one product question. On the recovery, I'm very -- obviously, FX is a unknowable factor that's going to continue. But I'm curious, to what extent are some of the other macro headwinds stabilizing or even improving?

邁克，丹，2 個問題。也許只是在復蘇，只有一張大圖和一個產品問題。關於復蘇，我非常 - 顯然，外匯是一個將繼續存在的不可知因素。但我很好奇，其他一些宏觀逆風在多大程度上穩定甚至改善？

Particularly staffing. I keep saying to myself, if staffing were less of an issue, maybe you would have grown even more rapidly. Is staffing still an issue?

特別是人員配備。我一直對自己說，如果人員配備不是問題，也許你會發展得更快。人員配備仍然是一個問題嗎？

Are things stabilizing in general on the freight and cost side, or getting worse?

貨運和成本方面的情況總體上趨於穩定，還是變得更糟？

And then I have a product follow-up question.

然後我有一個產品跟進問題。

Sure. On the hospital staffing, you've seen some of the big public companies, hospital chains report. Maybe it's gotten incrementally better, but certainly still quite a challenge for hospitals. Despite that, the procedure volumes are quite healthy despite some of the staffing shortages.

當然。在醫院人員配置方面，你已經看到了一些大型上市公司，連鎖醫院報告。也許它已經變得越來越好，但對醫院來說肯定仍然是一個相當大的挑戰。儘管如此，儘管存在一些人員短缺，但程序量還是相當健康的。

Could they be a little bit better if the shortage were improved? Likely. But they're doing a nice job of managing it, and it's forcing us to be innovative with them on reducing procedure times, which we continue to do, find ways through our portfolio. So staffing may be slightly better, but still a very tough environment for hospitals. It might provide some upside over time as that gets better, but it's going to get better more slowly, not overnight.

如果短缺得到改善，他們會不會好一點？可能。但是他們在管理它方面做得很好，這迫使我們在減少程序時間方面與他們一起創新，我們將繼續這樣做，通過我們的產品組合找到方法。因此，人員配備可能會稍微好一些，但對醫院來說仍然是一個非常艱難的環境。隨著時間的推移，它可能會隨著時間的推移提供一些好處，但它會變得更慢，而不是一夜之間。

And the other headwinds we talked about. Dan, I think the $375 million-ish of incremental supply chain, bucketed supply chain costs versus '19. And the biggest -- we are seeing some slight improvement in some of the freight areas, and we expect some slight improvements ongoing there in '23.

還有我們談到的其他不利因素。丹，我認為 3.75 億美元的增量供應鏈與 19 年相比，供應鏈成本增加了。最大的 - 我們看到一些貨運領域略有改善，我們預計在 23 年會有一些輕微的改善。

The bigger bucket that's most impactful is the product cost. The material cost, the supplies and raw materials that we purchase. And due to some of the shortages there, we had tied up some longer-term contracts to ensure supply, but those have come at more hefty price increases. So that bucket, we don't see getting better in 2023. So we think we'll carry that forward in 2023 as you annualize those contracts. Some of the other areas will get more efficient, the productivity of our manufacturing plants and so forth.

影響最大的是產品成本。我們採購的材料成本、供應品和原材料。由於那裡的一些短缺，我們捆綁了一些長期合同以確保供應，但這些合同的價格上漲幅度更大。所以那個桶，我們認為 2023 年不會變得更好。所以我們認為我們將在 2023 年將這些合同年化時繼續推進。其他一些領域將變得更有效率，比如我們的製造工廠的生產力等等。

So as Dan mentioned, we expect to carry many of these supply chain headwinds, primarily for material cost, into our 2023 plans. But similar to this year, we did improve margins 70 bps versus '21. Our goal will be to continue to improve margins in '23 and manage through that.

因此，正如丹所提到的，我們希望將這些供應鏈的許多不利因素（主要是材料成本）納入我們的 2023 年計劃。但與今年類似，與 21 年相比，我們確實將利潤率提高了 70 個基點。我們的目標是在 23 年繼續提高利潤率並通過這一點進行管理。

That's great, Mike. And just it's hard to resist asking about FARAPULSE. It sounds like things are going extremely well. Can you talk about drivers of the demand for FARAPULSE in Europe? Maybe any incremental color on centers opened? And just maybe update us, remind us if everything is still on track for data -- U.S. data readout in '23 and approval in '24?

太好了，邁克。只是很難抗拒詢問 FARAPULSE。聽起來事情進展得非常順利。您能談談歐洲對 FARAPULSE 需求的驅動因素嗎？也許中心打開的任何增量顏色？或許可以更新我們，提醒我們是否一切都在數據的正軌上——美國在 23 年的數據讀出和 24 年的批准？

Thanks, Rick. I'll have Dr. Stein cover that one.

謝謝，瑞克。我會讓 Stein 博士蓋上那個。

Yes, sure. Thanks, Mike. And thanks, Rick, for the question. We're very pleased with the commercial rollout in Europe to date, both in terms of continued procedure growth at the centers where we have opened, and being able to open new centers as we continue the product launch.

是的，當然。謝謝，邁克。謝謝瑞克的提問。我們對迄今為止在歐洲的商業推廣感到非常高興，無論是在我們開設中心的持續程序增長方面，還是在我們繼續推出產品時能夠開設新中心。

And I think that the drivers are really what we've always said is the promise of the FARAPULSE technology, right? Its enhanced safety as compared to thermal ablation, it's proving to be at least as efficacious if not more effective. And certainly, as Mike mentioned in terms of the issue with headwinds with staffing, it's a much more efficient procedure. And really just couldn't be happier with what we're seeing in terms of outcomes in Europe to date.

而且我認為驅動程序確實是我們一直所說的 FARAPULSE 技術的承諾，對吧？與熱消融相比，它增強了安全性，事實證明它至少同樣有效，如果不是更有效的話。當然，正如邁克在人員配備方面的逆風問題所提到的那樣，這是一個更有效的程序。迄今為止，我們在歐洲看到的結果真的是再高興不過了。

We have completed enrollment in our U.S. IDE trial that was the ADVENT trial. And again, still on track to finish follow-up for the primary endpoint of that data in sort of midterm next year and then submit to the FDA, and then it's all in the hands of the regulators.

我們已完成美國 IDE 試驗的註冊，即 ADVENT 試驗。再一次，仍有望在明年中期完成對該數據主要終點的跟進，然後提交給 FDA，然後一切都掌握在監管機構的手中。

The next question comes from Matthew O'Brien with Piper Jaffray.

下一個問題來自 Matthew O'Brien 和 Piper Jaffray。

Let me offer my congratulations to Dr. Meredith as well on his retirement.

讓我祝賀 Meredith 博士以及他的退休。

Mike, it seems like you're taking a little bit of near-term pain right now to continue your spending in these growth areas because you continue to be one of the faster-growth diversified med tech names out there. So I'm just curious if you feel like that momentum is going to continue into '23, where you can stay one of the faster-growth large-cap med tech names out there. And if it's going to be more of a broad-based level of improvement across all the different franchises, where you can keep kind of growing in this double-digit range in some areas? Or if it's going to be a little bit more focal than what we've seen historically. I don't know if it's specifically in Cardiology or other areas.

邁克，您現在似乎正在承受一些近期的痛苦，以繼續在這些增長領域進行支出，因為您仍然是那裡增長更快的多元化醫療技術公司之一。所以我很好奇你是否覺得這種勢頭會持續到 23 年，在那裡你可以保持增長更快的大型醫療技術公司之一。如果這將是所有不同特許經營權的更廣泛的改進水平，那麼您可以在某些領域保持這種兩位數的增長嗎？或者，如果它比我們在歷史上看到的更集中一點。我不知道它是專門在心髒病學還是其他領域。

Sure. What you've seen the performance this year is pretty consistent across all of our divisions, 6 of 8 grew double digits in the quarter. And you've seen similar performance throughout the year because of the innovation and commercial teams that we have. And our -- each quarter, as we mentioned many times, the lower-growth markets, that mix of those businesses get smaller each quarter and we layer on M&A and new innovation to grow faster. So that's kind of our formula, and it's proven to work pretty well.

當然。你所看到的今年我們所有部門的表現都相當一致，本季度 8 個部門中有 6 個增長了兩位數。由於我們擁有的創新和商業團隊，您全年都看到了類似的表現。正如我們多次提到的那樣，我們每個季度的低增長市場，這些業務的組合每個季度都會變小，我們在併購和新創新上進行分層以更快地增長。所以這就是我們的公式，並且證明效果很好。

As we look in some of the decisions that we make, we're very excited about the portfolio of significant launches that we have. Most of the significant -- very significant, [mobile-needing] launch -- move-the-needle launches, are more in the '24, '25 period. And that's where you're seeing the great growth in Europe, whether it be our ACURATE neo valve, the AGENT balloon that we're excited about, which we think will change really the script in coronary, and that will launch next year in Japan. And as Dr. Stein just mentioned, our EP portfolio with FARAPULSE and cryo is doing exceptionally well outside the U.S. And we have other launches.

當我們審視我們做出的一些決定時，我們對我們擁有的重大發布產品組合感到非常興奮。大多數重要的 - 非常重要的，[移動需求] 發布 - 移動針發布，更多的是在 '24，'25 時期。這就是你在歐洲看到巨大增長的地方，無論是我們的 ACURATE neo 瓣膜，還是我們興奮的 AGENT 氣球，我們認為這將真正改變冠狀動脈的劇本，並將於明年在日本推出.正如 Stein 博士剛剛提到的，我們與 FARAPULSE 和 cryo 的 EP 產品組合在美國以外的市場表現非常出色，而且我們還有其他產品推出。

So that does require quite a bit of R&D and clinical work. We'll be starting a persistent trial with FARAPULSE in the coming months here. So we think our R&D spend is appropriate to fuel that consistent above peer market growth over the LRP. In '23, we'll give guidance in February. We will have a bit tougher comps in '23 based on the performance of the estimated 9% growth this year. But if you look at -- we're excited what '23 will bring, and we'll give more guidance there.

所以這確實需要相當多的研發和臨床工作。在接下來的幾個月裡，我們將在這裡開始對 FARAPULSE 的持續試驗。因此，我們認為我們的研發支出適合推動 LRP 持續高於同行市場的增長。在 23 年，我們將在 2 月提供指導。根據今年估計增長 9% 的表現，我們將在 23 年進行更嚴格的比賽。但是如果你看一下——我們很高興 23 年會帶來什麼，我們會在那裡提供更多指導。

But if you look at the company and what we have for the future, based on what we're seeing in Europe and the clinical science that we're delivering, whether it be in our Interventional Oncology business or EP business, we're quite confident in the next LRP that will consistently grow above the peer group.

但如果你看看這家公司和我們對未來的看法，基於我們在歐洲看到的情況和我們正在提供的臨床科學，無論是在我們的介入腫瘤學業務還是 EP 業務，我們都非常對下一個將持續增長超過同行組的 LRP 充滿信心。

The next question comes from Matt Taylor with Jefferies.

下一個問題來自 Jefferies 的 Matt Taylor。

Can you hear me okay?

你能聽到我的聲音嗎？

Yes. Hear you fine, Matt.

是的。聽你的很好，馬特。

Okay. So I wanted to circle back and just ask one about Q4. Just on the 7% to 9% organic versus the 11%-plus that you did this quarter. Obviously, the comp is tougher. But is there anything else you'd call out there? Are you seeing anything slow down? Are you being conservative? Any highlights on just kind of the delta quarter-over-quarter?

好的。所以我想回過頭來問一個關於第四季度的問題。就在 7% 到 9% 的有機率與您本季度所做的 11% 以上。顯然，比賽更加艱難。但是你還有什麼要說的嗎？你看到有什麼變慢了嗎？你保守嗎？關於季度環比增量的任何亮點？

I think it's really just the comp, which is the better part of 250 basis points more difficult. And Neuromod is lower than the average of the rest of the businesses. But as we've continued to say, 6 of 8 double digits in Q3, continued momentum with a lot of the good new product launches we have, both in the U.S. and internationally. So I think the business has great momentum. And I think once you clear for the comp, it's a great Q4. And if we deliver 9% organic revenue growth for the full year versus '21, I think that will be a great year for the company.

我認為這實際上只是比較，這是 250 個基點中更好的部分更難。 Neuromod 低於其他企業的平均水平。但正如我們繼續說的那樣，第三季度 8 位兩位數中有 6 位繼續保持勢頭，我們在美國和國際上推出了許多優秀的新產品。所以我認為這個業務有很大的發展勢頭。而且我認為一旦你清除了比賽，這是一個很棒的第四季度。如果與 21 年相比，我們全年實現 9% 的有機收入增長，我認為這對公司來說將是偉大的一年。

Great. Can I ask one follow-up? I just wanted to know. We heard more about pent-up demand signs from some of the other peers that have reported. Would you espouse that? Are you seeing signs of that start to come due? And how do you square that, I guess, with staffing getting slightly better? What are the things that, I guess, could release over the next couple of quarters to help with the volumes?

偉大的。我可以問一個後續嗎？我只是想知道。我們從報告的其他一些同行那裡聽到了更多關於被壓抑的需求跡象。你會支持嗎？您是否看到開始出現這種情況的跡象？我猜，隨著人員配備的改善，你如何解決這個問題？我想，在接下來的幾個季度裡，有哪些東西可以幫助增加銷量？

We think the volume is pretty good. And there is certainly pent-up demand, but it's been in the system for a while. You look at your typical backlog, whether it be a knee replacement or a AFib product or whatever, a men's health implant. Oftentimes, you're getting a 60- to 120-day wait in the U.S.

我們認為音量非常好。當然還有被壓抑的需求，但它已經在系統中存在了一段時間。你看看你的典型積壓，無論是膝關節置換術還是 AFib 產品或其他什麼，男性健康植入物。通常，您在美國要等待 60 到 120 天。

And so there's certainly pent-up demand, but I don't see that getting cured in the near term. I think there's just a very strong patient demand. There is a bit of a staffing shortage. There's only so many labs that a hospital has to do procedures. And so we see pretty strong volume, which I guess is a good sign for the future here despite some of the staffing shortages, and just hospitals extremely busy, lab time very busy and demand that outstrips their supply in many cases that drive the waitlist. But we don't see that waitlist dramatically changing in the coming months.

所以肯定有被壓抑的需求，但我認為短期內不會得到治愈。我認為患者的需求非常強烈。人員有點短缺。只有這麼多的實驗室，醫院必須做的程序。因此，我們看到了相當強勁的銷量，儘管存在一些人員短缺，但我認為這對這裡的未來來說是一個好兆頭，而且只是醫院非常繁忙，實驗室時間非常繁忙，而且在許多情況下，需求超過了供應，從而推動了候補名單。但我們認為未來幾個月候補名單不會發生巨大變化。

The next question comes from Pito Chickering with Deutsche Bank.

下一個問題來自德意志銀行的 Pito Chickering。

Now it's been a while since the last COVID spike, have you seen the funnel for patients to get procedures normalize across your product portfolio versus pre-COVID levels? Or are you seeing any bottlenecks within that funnel as you think about your organic growth? And just to be clear, this isn't about necessarily nurse staffing at hospitals, but all the touch points across the health care system.

現在距離上一次 COVID 飆升已經有一段時間了，您是否看到了讓患者在您的產品組合中與 COVID 之前的水平相比，使程序正常化的漏斗？或者當您考慮有機增長時，您是否看到該渠道中的任何瓶頸？需要明確的是，這不一定是醫院的護士人員配置，而是整個醫療保健系統的所有接觸點。

Yes, I think -- thank you. I think it's similar to the last response. It depends on the region of the world. We did see a slowdown in third quarter in Japan. And you see pockets in China and sometimes pockets all over the world, depending on what happens with COVID. But overall, that's been smoothed out with the underlying pretty good procedure growth and us doing a bit better.

是的，我想——謝謝。我認為這與上一個響應相似。這取決於世界的地區。我們確實看到日本第三季度出現放緩。你會在中國看到口袋，有時甚至在世界各地看到口袋，這取決於 COVID 發生的情況。但總的來說，隨著潛在的相當不錯的程序增長和我們做得更好一些，這已經被平滑了。

And so again, I think as you look to fourth quarter and '23 here, staffing shortage still is an issue. It's not going to be resolved in '23. Hospitals are being very innovative to try to shore that up. But a strong patient demand, common to see longer wait list, so we do see pretty consistent demand. But we don't see a quick fix for the staffing shortage. But the underlying demand still strong despite that.

再說一次，我認為當你看第四季度和 23 年時，人員短缺仍然是一個問題。它不會在 23 年得到解決。醫院正在非常創新地嘗試支持這一點。但患者需求強勁，通常會看到更長的等待名單，因此我們確實看到了相當一致的需求。但我們沒有看到人員短缺的快速解決方案。但儘管如此，潛在需求仍然強勁。

The next question comes from Chris Pasquale with Nephron Research.

下一個問題來自 Nephron Research 的 Chris Pasquale。

I wanted to follow up on the increased prior auth denials in Neuromod. You talked about helping physicians with documentation, but what about addressing the underlying payer reticence to allow access to those therapies? Do you think more clinical data can help? And what could you have planned on that front?

我想跟進 Neuromod 中增加的先前身份驗證拒絕。您談到了幫助醫生提供文件，但是如何解決潛在的付款人沉默以允許獲得這些療法呢？你認為更多的臨床數據會有所幫助嗎？你在這方面有什麼計劃？

Really much more to come. The team does quite a bit with our clinical studies that we do for product approvals. It's a well-accepted therapy across -- it's been -- it's a pretty mature market in terms of number of competitors and clinical science that's actually increased quite a bit the last few years.

真的還有很多。該團隊在我們為產品批准所做的臨床研究中做了很多工作。這是一種廣為接受的療法——它一直是——就競爭對手和臨床科學的數量而言，它是一個相當成熟的市場，在過去幾年中實際上增加了很多。

Part of it is the payers. We certainly work with our HEMA teams to contact those payers directly and reemphasize that clinical evidence. But it's really a bit of the -- just some of the recent preauthorization denials that just need to be worked through in terms of their efficiency. And we aim to improve that process.

其中一部分是付款人。我們當然會與我們的 HEMA 團隊合作，直接聯繫這些付款人，並再次強調臨床證據。但這確實有點——只是最近的一些預授權拒絕，就其效率而言需要解決。我們的目標是改進這一過程。

I don't think it's related to any -- it's not related -- the slowdown is not related to any poor clinical data. There's good clinical data at Boston Scientific and our peer group. And it's well established by the implanter, whether it be a pain physician or an orthopedic physician. It's well proven out. I think it's working through some of the mechanics of these preauthorization denials is the issue. But I also think overall, the market is a bit slower, even excluding that, than it was historically.

我不認為這與任何 - 它不相關 - 放緩與任何不良的臨床數據無關。波士頓科學公司和我們的同行團隊有很好的臨床數據。無論是疼痛醫師還是骨科醫師，植入者都可以很好地建立它。這是很好的證明。我認為它正在解決這些預授權拒絕的一些機制是問題所在。但我也認為，總體而言，市場比歷史上要慢一些，即使不包括在內。

Okay. And then renal innovation is going to be a hot topic at AHA. Boston had a program there at one time with Vessix. How are you thinking about the potential of that therapy and Boston's ability to participate there if it does become a new growth driver in cardiology?

好的。然後腎臟創新將成為 AHA 的熱門話題。波士頓曾經與 Vessix 有一個項目。如果該療法確實成為心髒病學的新增長動力，您如何看待該療法的潛力以及波士頓參與其中的能力？

I'll have Dr. Meredith take that one.

我會讓 Meredith 博士拿走那個。

Yes. Thanks, Chris. It's a good question. Yes, we will see Medtronic's hypertension study come out at the AHA. And we just saw the RADIANCE II trial results come out the TCT with Ultrasound.

是的。謝謝，克里斯。這是個好問題。是的，我們將在美國心臟協會看到美敦力的高血壓研究。我們剛剛看到 RADIANCE II 試驗結果在 TCT with Ultrasound 中出爐。

This is a real therapy, and hypertension is an enormous cardiovascular problem globally, and we follow this space very carefully. This is a significant opportunity. Obviously, the results still could be improved. If you look, there's significant variability in the treated arm effect, and that probably reflects that we've got more to do to understand in whom we should be using this form of therapy. But it's a real opportunity. Hypertension is a massive cardiovascular problem. We follow the field very closely. It's one that we have to pay attention to.

這是一種真正的療法，高血壓在全球範圍內是一個巨大的心血管問題，我們非常仔細地關注這個領域。這是一個重要的機會。顯然，結果仍有待改進。如果您仔細觀察，治療後的手臂效果存在顯著差異，這可能反映了我們還有更多工作要做，以了解我們應該在誰身上使用這種形式的治療。但這是一個真正的機會。高血壓是一個嚴重的心血管問題。我們密切關注該領域。是我們必須要注意的。

Thanks and congrats, Dr. Meredith.

謝謝和祝賀，梅雷迪思博士。

Thank you.

謝謝你。

And I understand there is time for one last question, and that would be from Matt Miksic with Barclays.

我知道有時間來回答最後一個問題，那就是來自巴克萊銀行的馬特·米克西奇。

So congrats on a really strong quarter. And Dr. Meredith, we'll certainly miss your insights and your cheerful disposition. And I guess I'm thankful to that I've got about 6 months to get to know this humorous side that everyone is referring to. So I look forward to that.

所以祝賀一個非常強勁的季度。還有梅雷迪思博士，我們肯定會想念你的洞察力和你開朗的性格。我想我很慶幸我有大約 6 個月的時間來了解每個人都提到的幽默的一面。所以我很期待。

Just one follow-up, if I could, on margins. Dan, you talked about the impact of FX, and it seems like that explains pretty much the $0.03 reduction in EPS guide for the year. Just maybe one question on trajectory. It's such a strong Q3 here. You're adjusting Q4 for EPS and top end of the range for organic growth. That strikes me as a little bit conservative, just given the strength, but I'd love your comment on that.

如果可以的話，只需在利潤上進行一次後續行動。丹，你談到了外彙的影響，這似乎解釋了今年每股收益指南減少 0.03 美元的原因。可能只是關於軌蹟的一個問題。這是一個如此強勁的第三季度。您正在調整第四季度的每股收益和有機增長范圍的高端。考慮到力量，這讓我覺得有點保守，但我希望你對此發表評論。

And then maybe you're not talking much about '23, but the shape of margins. And I know there's been a lot of questions around how far into '23 some of the higher costs will go. And if we were to think about -- is this sort of a front half, back half that we should be thinking about for '23 at this point? Or I'm sure it's too early to say, but any insight you can give on how we should think about costs as they roll through inventory and P&L and so on.

然後也許你不是在談論'23，而是在談論邊距的形狀。而且我知道有很多關於到 23 年一些更高的成本會走多遠的問題。如果我們要考慮 - 這種前半部分，後半部分我們應該在這一點上考慮 23 年嗎？或者我敢肯定現在說還為時過早，但是您可以就我們應該如何考慮成本在庫存和損益等方面的滾動提供任何見解。

Sure, Matt. A lot to chew on in that question. So the -- first, I agree with your assertion. The $1.71 to $1.74 from the $1.74 to $1.77 adjusted earnings per share guidance for the year, that is FX. That's down $0.03. FX is -- the FX impact on EPS was $0.03. It is now $0.06. So that is the difference for the $1.71 to $1.74 change in guidance.

當然，馬特。在這個問題上有很多東西要咀嚼。所以——首先，我同意你的說法。從 1.74 美元至 1.77 美元的年度調整後每股收益指引為 1.71 美元至 1.74 美元，即外匯。這下降了 0.03 美元。外匯是——外匯對每股收益的影響為 0.03 美元。現在是 0.06 美元。這就是 1.71 美元至 1.74 美元的指導變化的差異。

On the revenue for Q4, your comment that it appears conservative, I think it's appropriate. I think we've looked at all the different variables that are there, the momentum in the business, and we think that the guidance we gave is appropriate.

關於第四季度的收入，您的評論似乎保守，我認為這是合適的。我認為我們已經研究了所有不同的變量，業務的發展勢頭，我們認為我們給出的指導是適當的。

And I think for 2023, I think it's just a bit early. I mean, I gave you a little bit of a teaser there on FX, given where we are with our hedging program. But I think other than that -- and obviously then, our goal is to continue to expand operating margin over time. But other than that, I'll probably just let you wait until we give guidance officially on all the specifics.

而且我認為對於 2023 年，我認為還為時過早。我的意思是，考慮到我們在對沖計劃中所處的位置，我在 FX 上給了你一點預告。但我認為除此之外 - 顯然，我們的目標是隨著時間的推移繼續擴大營業利潤率。但除此之外，我可能會讓你等到我們就所有細節正式給出指導。

But super excited about how the company has performed this year, and look forward to continuing that trend in '23 and beyond.

但對公司今年的表現感到非常興奮，並期待在 23 年及以後繼續這種趨勢。

All right. Thank you for joining us today. We appreciate your interest in Boston Scientific. If we were unable to get to your question or if you have any follow-ups, please don't hesitate to reach out to the Investor Relations team.

好的。感謝您今天加入我們。感謝您對波士頓科學的興趣。如果我們無法回答您的問題或您有任何後續問題，請隨時與投資者關係團隊聯繫。

Before you disconnect, Andrew will give you all the pertinent details for the replay. Thank you.

在您斷開連接之前，安德魯將為您提供重播的所有相關詳細信息。謝謝你。

Please note, a recording will be available in 1 hour by dialing either 1 (877) 344-7529 or 1 (412) 317-0088 using replay code 9072485 until November 2, 2022, at 11:59 p.m. Eastern Time.

請注意，在 2022 年 11 月 2 日晚上 11:59 之前，使用重播代碼 9072485 撥打 1 (877) 344-7529 或 1 (412) 317-0088 將在 1 小時內提供錄音。東部時間。

The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.

會議現已結束。感謝您參加今天的演講。您現在可以斷開連接。