史賽克 (SYK) 2022 Q3 法說會逐字稿

Welcome to the Third Quarter 2022 Stryker Earnings Call. My name is Megan, and I'll be your operator for today's call. (Operator Instructions) This conference call is being recorded for replay purposes.

歡迎來到 Stryker 2022 年第三季度財報電話會議。我的名字是梅根，今天我將擔任您的接線員。 （操作員說明）正在錄製此電話會議以供重播。

Before we begin, I would like to remind you that the discussions during this conference call will include forward-looking statements. Factors that could cause actual results to differ materially are discussed in the company's most recent filings with the SEC. Also, the discussions will include certain non-GAAP financial measures. Reconciliations to the most directly and comparable GAAP financial measures can be found in today's press release that is in exhibit to Stryker's current report on Form 8-K filed today with the SEC.

在開始之前，我想提醒您，本次電話會議期間的討論將包括前瞻性陳述。該公司最近向美國證券交易委員會提交的文件中討論了可能導致實際結果出現重大差異的因素。此外，討論將包括某些非公認會計原則的財務措施。可以在今天的新聞稿中找到與最直接和可比的 GAAP 財務指標的對賬，該新聞稿是 Stryker 今天向 SEC 提交的關於表格 8-K 的當前報告的展示。

I will now turn the call over to Mr. Kevin Lobo, Chair and Chief Executive Officer. You may proceed, sir.

我現在將把電話轉給主席兼首席執行官 Kevin Lobo 先生。你可以繼續，先生。

Welcome to Stryker's third quarter earnings call. Joining me today are Glenn Boehnlein, Stryker's CFO; and Jason Beach, Vice President of Investor Relations.

歡迎參加 Stryker 第三季度財報電話會議。今天加入我的是 Stryker 的首席財務官 Glenn Boehnlein；和投資者關係副總裁 Jason Beach。

For today's call, I will provide opening comments, followed by Jason with the trends we saw during the quarter and updates on Vocera and capital equipment. Glenn will then provide additional details regarding our quarterly results before opening the call to Q&A.

對於今天的電話會議，我將提供開場評論，然後是 Jason，介紹我們在本季度看到的趨勢以及 Vocera 和資本設備的更新。然後，格倫將在打開問答電話之前提供有關我們季度業績的更多詳細信息。

For the quarter, organic sales growth was 10%, with double digit growth from our MedSurg and Neurotechnology businesses, led by endoscopy, medical and neurocranial. Our hip and knee businesses also delivered double digit growth, reflecting the continued recovery of elective procedures and our worldwide Mako momentum. Lastly, we continued our strong international performance, with double digit organic growth, led by Europe, Canada and emerging markets, despite negative growth in China.

本季度，有機銷售額增長 10%，我們的 MedSurg 和神經技術業務實現了兩位數的增長，其中內窺鏡、醫療和神經顱內窺鏡業務處於領先地位。我們的髖關節和膝關節業務也實現了兩位數的增長，反映了選擇性手術的持續復甦和我們在全球範圍內的 Mako 勢頭。最後，儘管中國出現負增長，但我們繼續保持強勁的國際業績，在歐洲、加拿大和新興市場的帶動下實現了兩位數的有機增長。

For the quarter, we delivered adjusted EPS of $2.12 a share, driven by our strong sales performance, partially offsetting negative foreign currency and inflationary pressures. We expect these pressures to continue but at a more moderate level for the remainder of 2022. We are pleased with our strong sales growth, which would have been even higher if not for material shortages mostly affecting medical and instruments. Meanwhile, we are taking actions to deal with the cost headwinds, including inflationary challenges.

本季度，在我們強勁的銷售業績的推動下，我們實現了每股 2.12 美元的調整後每股收益，部分抵消了負面的外彙和通脹壓力。我們預計這些壓力將繼續存在，但在 2022 年剩餘時間內將處於較為溫和的水平。我們對強勁的銷售增長感到滿意，如果不是因為主要影響醫療和儀器的材料短缺，銷售增長會更高。與此同時，我們正在採取行動應對成本逆風，包括通脹挑戰。

First, as noted in Q2, given the higher input costs, we took a series of pricing actions across our portfolio. We have begun to see the impact of these initiatives, lessening the negative price impact on our business in Q3, but it will take time to see the full effect, given the timing of contract renewals and rebates from prior contracts expiring.

首先，如第二季度所述，鑑於較高的投入成本，我們在我們的投資組合中採取了一系列定價措施。我們已經開始看到這些舉措的影響，減輕了第三季度對我們業務的負面價格影響，但考慮到合同續籤的時間和先前合同到期的回扣，需要時間才能看到全部效果。

Second, we have taken additional actions around cost, including the reduction of discretionary items, hiring actions, and are proceeding with target restructuring plans in parts of our business. We continue to invest in R&D, demonstrating our continued focus on new product pipelines. This includes investments in R&D for enabling technologies, robotics, imaging and navigation, including our recently launched Q Guidance navigation system in spine.

其次，我們圍繞成本採取了額外的行動，包括減少可自由支配的項目、招聘行動，並正在我們的部分業務中實施目標重組計劃。我們繼續投資於研發，表明我們對新產品管道的持續關注。這包括對支持技術、機器人、成像和導航的研發投資，包括我們最近推出的脊柱 Q Guidance 導航系統。

Notably, we are making good progress with the development of our spine and shoulder applications for Mako. We have stopped the Cardan spine robotic project to focus all our energies on Mako and expect that the Mako spine and shoulder launches will occur in a similar time frame.

值得注意的是，我們在為 Mako 開發脊柱和肩部應用程序方面取得了良好進展。我們已經停止了 Cardan 脊柱機器人項目，將我們所有的精力集中在 Mako 上，並期望 Mako 脊柱和肩部的發射將在類似的時間框架內發生。

Also during the quarter, we signed an agreement to purchase Cerus Endovascular, a technology leader in the hemorrhagic segment. This deal is pending customary closing conditions. We remain confident in the outlook of our business and expect to continue to deliver sales growth at the high end of med tech, which is reflected in our narrowing of full year organic sales growth to the higher end of our prior range, now 8.5% to 9%. However, worsening foreign currency and continued inflationary pressures have caused us to lower our full year adjusted EPS range to $9.15 to $9.25 per share.

同樣在本季度，我們簽署了一項收購 Cerus Endovascular 的協議，該公司是出血性領域的技術領導者。這筆交易正在等待慣例成交條件。我們對我們的業務前景仍然充滿信心，並預計將繼續在醫療技術的高端實現銷售增長，這反映在我們將全年有機銷售增長收窄至之前範圍的高端，目前為 8.5% 至9%。然而，不斷惡化的外彙和持續的通脹壓力導致我們將全年調整後的每股收益範圍降低至每股 9.15 美元至 9.25 美元。

Overall, our team has shown good resiliency, and I'm pleased that employee engagement remains very high. We continue to be recognized across many countries, professions, gender and age groups as a great place to work, most recently as one of the world's best workplaces by Fortune.

總體而言，我們的團隊表現出良好的彈性，我很高興員工敬業度仍然很高。我們繼續在許多國家、職業、性別和年齡組中被公認為是理想的工作場所，最近被《財富》雜誌評為全球最佳工作場所之一。

As we look ahead to 2023, we feel optimistic about growth with high customer demand and exciting new product launches. Though the inflationary pressures and supply chain challenges will continue to impact next year, the strong growth outlook, combined with our pricing and cost actions, will position us well to return to strong earnings growth.

展望 2023 年，我們對高客戶需求和令人興奮的新產品發布感到樂觀。儘管通脹壓力和供應鏈挑戰將繼續影響明年，但強勁的增長前景，再加上我們的定價和成本行動，將使我們能夠恢復強勁的盈利增長。

I will now turn the call over to Jason.

我現在將把電話轉給傑森。

Thanks, Kevin. My comments today will focus on providing an update on the current environment, including the procedural, geographic and capital trends during the quarter. In addition, I'll provide an update on the integration progress of the Vocera business.

謝謝，凱文。我今天的評論將集中在提供當前環境的最新信息，包括本季度的程序、地理和資本趨勢。此外，我將提供有關 Vocera 業務整合進展的最新信息。

Procedural volumes continue to recover throughout the third quarter in most countries, and we are beginning to reach normalized levels across most of our business. While we are seeing volumes recover, hospital staffing pressures have continued to impact the ability to reduce procedural backlog in a meaningful way. These challenges will likely resolve gradually, and we continue to expect this will be a moderate tailwind into next year.

在大多數國家/地區，第三季度的程序量繼續恢復，我們的大部分業務開始達到正常水平。雖然我們看到數量有所回升，但醫院人員配備壓力繼續影響以有意義的方式減少程序積壓的能力。這些挑戰可能會逐漸解決，我們繼續預計這將是明年的溫和順風。

Geographically, procedural volumes steadily improved during the quarter in the United States, Europe and Latin America. Parts of Asia Pacific have continued to be more volatile due to ongoing COVID-related impacts. Demand for our capital products remained very strong in the quarter, as seen from the double-digit growth of our Medical division. However, we did realize some installation delays as well as hospital scheduling challenges.

從地域上看，本季度美國、歐洲和拉丁美洲的程序量穩步提高。由於持續的與 COVID 相關的影響，亞太地區的部分地區繼續更加動盪。從我們醫療部門的兩位數增長可以看出，本季度對我們資本產品的需求仍然非常強勁。然而，我們確實意識到了一些安裝延遲以及醫院調度方面的挑戰。

Specific to Mako, installations for the quarter were soft as we realized delays stemming from variability in the hospital environment. However, our order book remains strong, and we expect a good fourth quarter for Mako. We will update you on our key Mako metrics in January.

具體到 Mako，當我們意識到醫院環境的可變性導致延誤時，本季度的安裝情況較為疲軟。然而，我們的訂單依然強勁，我們預計 Mako 的第四季度業績良好。我們將在一月份向您更新我們的關鍵 Mako 指標。

Now to our key integration activities. We continue to be pleased with our Vocera integration progress and remain excited about the strong growth potential of this platform technology. However, in Q3, we elected to delay some installations shifting from on-prem servers to our cloud solution with certain customers. Also, as we do with all acquisitions, we are shifting the legacy sales force to the Stryker model, which has caused some disruption. These delays resulted in revenues that were essentially flat to Q3 2021.

現在到我們的關鍵集成活動。我們繼續對 Vocera 集成進展感到滿意，並對這一平台技術的強大增長潛力感到興奮。但是，在第三季度，我們選擇推遲一些安裝，將某些客戶從本地服務器轉移到我們的雲解決方案。此外，正如我們對所有收購所做的那樣，我們正在將傳統銷售隊伍轉移到 Stryker 模式，這造成了一些混亂。這些延遲導致收入與 2021 年第三季度基本持平。

However, the order pipeline remains strong and customer retention remains very high at 99% for software renewals. We expect these processes to continue into Q1 of next year, after which we will be positioned to drive robust sales growth.

但是，訂單渠道仍然強勁，軟件續訂的客戶保留率仍然很高，達到 99%。我們預計這些流程將持續到明年第一季度，之後我們將有能力推動強勁的銷售增長。

In summary, while the macroeconomic environment remains dynamic, procedural volumes are improving, and the underlying demand for our products remain strong, which gives us confidence in our ability to continue to drive strong revenue growth.

總而言之，儘管宏觀經濟環境依然充滿活力，但程序量正在改善，對我們產品的潛在需求依然強勁，這讓我們對繼續推動強勁收入增長的能力充滿信心。

With that, I'll turn the call over to Glenn.

有了這個，我會把電話轉給格倫。

Thanks, Jason. Today, I will focus my comments on our third quarter financial results and the related drivers. Our detailed financial results have been provided in today's press release.

謝謝，傑森。今天，我將把我的評論集中在我們的第三季度財務業績和相關驅動因素上。我們的詳細財務業績已在今天的新聞稿中提供。

Our organic sales growth was 9.9% in the quarter. The third quarter's average selling days were in line with 2021. The impact from pricing in the quarter was unfavorable 0.7%. We have started to see the positive impact of pricing initiatives, particularly in our U.S. MedSurg businesses, which all had positive pricing for the quarter. Foreign currency had a 3.7% unfavorable impact on sales. We continue to experience supply chain disruptions that have increased costs and led to inconsistent product availability. This is especially impacting the shipping and delivery time lines related to capital products in our MedSurg businesses. Nevertheless, our capital order book continues to be very robust as demand from our customers remained strong.

本季度我們的有機銷售額增長了 9.9%。第三季度的平均銷售天數與 2021 年一致。該季度定價的不利影響為 0.7%。我們已經開始看到定價舉措的積極影響，特別是在我們的美國 MedSurg 業務中，這些業務在本季度都有積極的定價。外幣對銷售產生了 3.7% 的不利影響。我們繼續經歷供應鏈中斷，這增加了成本並導致產品可用性不一致。這尤其影響了我們 MedSurg 業務中與資本產品相關的運輸和交付時間線。儘管如此，由於客戶的需求依然強勁，我們的資本訂單仍然非常強勁。

In the quarter, U.S. organic sales growth was 9.2%. International organic sales growth was 11.8%, impacted by positive sales momentum across most of our international markets, specifically emerging markets, Canada, Japan and Europe, somewhat offset by lingering COVID impacts in other Asia Pac countries. Our adjusted EPS of $2.12 in the quarter was down $0.08 from 2021, due primarily to the impact of foreign currency exchange translation of $0.08. Additionally, higher costs associated with gross margin challenges were offset by the benefit from higher sales and cost discipline.

本季度，美國有機銷售額增長 9.2%。國際有機銷售額增長 11.8%，受我們大部分國際市場，特別是新興市場、加拿大、日本和歐洲的積極銷售勢頭的影響，在一定程度上被其他亞太地區國家揮之不去的 COVID 影響所抵消。我們在本季度調整後的每股收益為 2.12 美元，比 2021 年下降了 0.08 美元，這主要是由於外幣兌換 0.08 美元的影響。此外，與毛利率挑戰相關的更高成本被更高的銷售和成本紀律帶來的好處所抵消。

Now I'll provide some highlights around our segment performance. In the quarter, MedSurg and Neurotechnology had constant currency sales growth of 13.5%, with organic sales growth of 10.8%, which included 9.6% of U.S. organic growth and 14.4% of international organic growth. Instruments had U.S. organic sales growth of 2.2%, led by our Surgical Technology business. From a product perspective, sales growth was highlighted by growth in smoke evacuation and Steri-Shield. During the quarter, Instruments experienced supply chain challenges, primarily related to its capital products.

現在，我將圍繞我們的細分市場表現提供一些亮點。本季度，MedSurg 和 Neurotechnology 的固定貨幣銷售額增長 13.5%，有機銷售額增長 10.8%，其中包括美國有機增長的 9.6% 和國際有機增長的 14.4%。在我們的外科技術業務的帶動下，Instruments 在美國的有機銷售額增長了 2.2%。從產品的角度來看，排煙和 Steri-Shield 的增長突顯了銷售增長。在本季度，Instruments 經歷了主要與其資本產品有關的供應鏈挑戰。

Endoscopy had U.S. organic sales growth of 14%, highlighted by double-digit growth in both the core Endoscopy and Sports Medicine businesses. Medical had U.S. organic sales growth of 13.7% driven by growth in our Sage and acute care businesses, fueled by ProCuity and prime structure demand. As previously noted, Medical continues to experience supply chain challenges that primarily impact emergency care products.

內窺鏡在美國的有機銷售額增長了 14%，其中核心內窺鏡和運動醫學業務均實現了兩位數的增長。在 ProCuity 和主要結構需求的推動下，醫療業務在美國的有機銷售額增長了 13.7%，這得益於 Sage 和急性護理業務的增長。如前所述，醫療繼續面臨主要影響緊急護理產品的供應鏈挑戰。

Our U.S. Neurovascular business had an organic decline of 2%, driven by a strong double-digit comparable in 2021, disruptions due to hospital staffing shortages and slower clinic volumes as well as competitive pressures. The U.S. neurocranial business had organic sales growth of 12.7%, which included solid growth in our MAC space and neuro products. Internationally, MedSurg and Neurotechnology had organic sales growth of 14.4%, reflecting double digit growth in all businesses. Geographically, this included strong performances in Japan, China and other emerging markets.

我們的美國神經血管業務有機下降 2%，原因是 2021 年可比強勁的兩位數、醫院人員短缺和診所數量放緩以及競爭壓力導致的中斷。美國神經顱腦業務有機銷售額增長 12.7%，其中包括我們的 MAC 空間和神經產品的穩健增長。在國際上，MedSurg 和 Neurotechnology 的有機銷售額增長了 14.4%，反映了所有業務的兩位數增長。從地域上看，這包括日本、中國和其他新興市場的強勁表現。

Orthopedics and Spine had both constant currency and organic sales growth of 8.7%, which included organic growth of 8.7% in the U.S., and 8.9% internationally. This reflects the impact of our strong international growth and solid growth in our hip, knee and trauma and extremities businesses. Our U.S. Hip business grew 12.4% organically, reflecting strong primary hip growth fueled by the recent launch of our Insignia Hip Stem and continued procedural growth.

骨科和脊柱的固定匯率和有機銷售額均增長 8.7%，其中美國有機增長 8.7%，國際有機增長 8.9%。這反映了我們強勁的國際增長以及髖關節、膝關節、創傷和四肢業務穩健增長的影響。我們的美國髖關節業務有機增長了 12.4%，這反映了最近推出的 Insignia Hip Stem 和持續的程序增長推動了強勁的初級髖關節增長。

Our U.S. [New York] knee business grew 14% organically, reflecting our market-leading position in robotic assisted knee procedures. Our U.S. trauma and extremities business grew 10.% organically, with strong performances across all 4 businesses, led by double digit growth in upper extremities, highlighted by our new products perform and Blueprint. Our U.S. Spine business sales grew 2% from solid performance in our enabling technology business, somewhat offset by the impact of lower surgery volumes in the competitive environment.

我們的美國 [紐約] 膝關節業務有機增長 14%，反映了我們在機器人輔助膝關節手術方面的市場領先地位。我們的美國創傷和四肢業務有機增長 10.%，所有 4 項業務均表現強勁，其中上肢業務實現兩位數增長，我們的新產品表現和藍圖突顯了這一點。我們的美國脊柱業務銷售額從我們的賦能技術業務的穩健表現中增長了 2%，這在一定程度上被競爭環境中手術量減少的影響所抵消。

Our U.S. other ortho declined organically by 11.2%, primarily driven by the impact of the aforementioned delays in Mako installations in the quarter. Internationally, orthopedics and spine grew 8.9% organically, which reflects the strong momentum in Europe, as procedural volumes improved as well as strong performances in Japan, Canada and India, somewhat offset by COVID-related volatility in Australia.

我們的美國其他正畸有機下降 11.2%，主要是受上述季度 Mako 安裝延遲的影響。在國際上，骨科和脊柱有機增長 8.9%，這反映了歐洲的強勁勢頭，因為日本、加拿大和印度的手術量有所改善以及表現強勁，但在一定程度上被澳大利亞與 COVID 相關的波動所抵消。

Now I will focus on the operating highlights in the third quarter. Our adjusted gross margin of 62.6% was unfavorable approximately 370 basis points from the third quarter of 2021, reflecting the impact of the purchases of electronic components at premium prices and other inflationary pressures, primarily related to labor, steel and transportation costs as well as inefficiencies from supply chain disruption and the unfavorable impact of price and foreign exchange on sales.

現在我將重點介紹第三季度的經營亮點。我們調整後的毛利率為 62.6%，較 2021 年第三季度不利約 370 個基點，反映了以高價購買電子元件和其他通脹壓力的影響，主要與勞動力、鋼鐵和運輸成本以及效率低下有關供應鏈中斷以及價格和外匯對銷售的不利影響。

Sequentially, from Q2 2022, gross margin was 70 basis points unfavorable. This included the impact from unfavorable business mix, higher-than-expected inflationary pressures, including premium pricing and operation inefficiencies. We expect these adverse impacts to continue throughout the remainder of the year and into 2023. For the full year 2022, we now expect adjusted gross margin compared to 2021 to be adversely impacted by approximately 250 basis points.

隨後，從 2022 年第二季度開始，毛利率為 70 個基點，不利。這包括不利的業務組合、高於預期的通脹壓力（包括溢價定價和運營效率低下）的影響。我們預計這些不利影響將在今年剩餘時間內持續到 2023 年。對於 2022 年全年，我們現在預計與 2021 年相比調整後的毛利率將受到約 250 個基點的不利影響。

Adjusted R&D spending was 7.1% of sales, which represent the 40 basis points increase from 2021. This reflects our continued commitment to funding innovation and the related future growth it will provide. Our adjusted SG&A was 33.1% of sales, which was 100 basis points lower than 2021. This reflects the impact of an increased focus on discretionary cost control and head count discipline.

調整後的研發支出佔銷售額的 7.1%，比 2021 年增加了 40 個基點。這反映了我們繼續致力於資助創新及其將提供的相關未來增長。我們調整後的 SG&A 佔銷售額的 33.1%，比 2021 年低 100 個基點。這反映了更加關注可自由支配成本控制和員工人數紀律的影響。

In summary, for the quarter, our adjusted operating margin was 22.3% of sales, which was approximately 310 basis points unfavorable to the third quarter 2021. This performance is primarily driven by the aforementioned gross margin challenges and the net negative impact resulting from foreign currency exchange translation, somewhat offset by cost discipline.

總而言之，本季度，我們調整後的營業利潤率為銷售額的 22.3%，比 2021 年第三季度不利約 310 個基點。這一業績主要受到上述毛利率挑戰和外匯帶來的淨負面影響的推動交換翻譯，在某種程度上被成本紀律所抵消。

Adjusted other income and expense decreased from 2021, primarily resulting from lower interest expense and favorable interest income. We anticipate Q4 OI&E to be approximately $70 million. Our third quarter had an adjusted effective tax rate of 14.5%, reflecting the impact of geographic mix and certain discrete tax items. We now expect our full year adjusted effective tax rate to be at the low end of our previously communicated range of 14.5% to 15%, which is slightly lower than 2021.

調整後的其他收入和支出較 2021 年有所減少，主要是由於利息支出減少和利息收入有利。我們預計第四季度 OI&E 約為 7000 萬美元。我們第三季度的調整後有效稅率為 14.5%，反映了地域組合和某些離散稅項的影響。我們現在預計全年調整後的有效稅率將處於我們之前傳達的 14.5% 至 15% 範圍的低端，略低於 2021 年。

Focusing on the balance sheet. We ended the third quarter with $1.5 billion of cash and marketable securities and total debt of $12.8 billion. Approximately $250 million of term loan debt was paid down in the quarter, which brings our year-to-date payments to $500 million.

專注於資產負債表。我們在第三季度結束時擁有 15 億美元的現金和有價證券，總債務為 128 億美元。本季度償還了大約 2.5 億美元的定期貸款債務，這使我們年初至今的還款額達到了 5 億美元。

Turning to cash flow. Our year-to-date cash from operations is $1.6 billion. This performance reflects the results of net earnings, partially offset by the impact of higher costs for certain electronic components, pre-buying of certain other critical raw material inventory and seasonal inventory increases.

轉向現金流。我們年初至今的運營現金為 16 億美元。這一業績反映了淨利潤的結果，部分被某些電子元件成本上升、某些其他關鍵原材料庫存的預購和季節性庫存增加的影響所抵消。

Considering our third quarter results, our strong order book for capital equipment and the sales momentum in our implant and capital businesses, we now expect full year 2022 organic sales growth to be in the range of 8.5% to 9%. If foreign currency exchange rates hold near current levels, we now expect net sales in the full year to be adversely impacted by approximately 4% and adjusted net earnings per diluted share to be adversely impacted by approximately $0.35 to $0.40 for the full year, which is included in our revised earnings guidance range.

考慮到我們第三季度的業績、我們強勁的資本設備訂單以及我們的植入和資本業務的銷售勢頭，我們現在預計 2022 年全年有機銷售增長將在 8.5% 至 9% 的範圍內。如果外匯匯率保持在當前水平附近，我們現在預計全年淨銷售額將受到約 4% 的不利影響，全年調整後每股攤薄淨收益將受到約 0.35 美元至 0.40 美元的不利影響，即包含在我們修訂後的收益指導範圍內。

Based on continuing inflationary and supply chain pressures, balanced with our strong sales and additional cost-reduction actions and most significantly, the anticipated future impact of foreign currency, we now expect adjusted earnings per share to be in the range of $9.15 to $9.25.

基於持續的通脹和供應鏈壓力，加上我們強勁的銷售和額外的成本削減行動，以及最重要的是外幣的預期未來影響，我們現在預計調整後的每股收益將在 9.15 美元至 9.25 美元之間。

And now I will open the call up for Q&A.

現在我將打開問答電話。

(Operator Instructions) Our first question comes from the line of Robbie Marcus with JPMorgan Chase.

（操作員說明）我們的第一個問題來自摩根大通的 Robbie Marcus。

Congrats on a really nice top line here. That said, I do want to ask my first question on operating margins, both for third quarter and fourth quarter. And it came in a lot lower. It looks like half was for currency. I think what I'd like to know is how much of what we saw to the negative was transient in third quarter? And what's driving the strong sequential improvement into fourth quarter here?

恭喜這裡的頂線非常好。也就是說，我確實想就第三季度和第四季度的營業利潤率提出我的第一個問題。而且它的價格要低得多。看起來一半是為了貨幣。我想我想知道的是，我們在第三季度看到的負面影響有多少是暫時的？是什麼推動了第四季度的強勁連續改善？

Robbie, this is Glenn. Good questions. As we looked at the third quarter and the impact and what changed from Q2 specifically, we just -- what we saw was we saw that our visibility to supply had improved and that we were seeing sort of moderate sort of improvement. But the rate of improvement relative to the cost was not improving at that kind of outlook. So we continue to see higher-than-expected premium costs.

羅比，這是格倫。好問題。當我們查看第三季度及其影響以及與第二季度相比發生的變化時，我們只是 - 我們看到的是我們看到我們的供應可見性有所改善，並且我們看到了適度的改善。但在這種前景下，相對於成本的改進率並沒有提高。因此，我們繼續看到高於預期的保費成本。

We saw other inflation across almost all categories, but as I noted, most noticeably in labor, metals, transportation. And then all of that and that sort of variability of supply chain really drove just inefficiencies in our manufacturing process. And so that -- we had lots of stops and starts, which, as you know, just drives up more cost.

我們在幾乎所有類別中都看到了其他通貨膨脹，但正如我所指出的，最明顯的是勞動力、金屬和運輸。然後所有這些以及供應鏈的那種可變性確實導致了我們製造過程的效率低下。所以 - 我們有很多停止和開始，如你所知，這只會增加更多成本。

So I think, if I think about it, what's transient, what's not, I think in Q4, we have good visibility to supply and feel confident enough to raise our sales guidance, which is what we did. And so we'll feel that in Q4. I still think we're going to see a little bit of this fluid environment where we'll continue to experience some higher costs. And I would tell you that once we get our hands around sort of one electronic component issues, then we'll be contacted from an n minus 2 vendor about another issue, and so we're feeling that sort of through -- as we're managing through sort of our supply chain issues.

所以我認為，如果我考慮一下，什麼是暫時的，什麼不是，我認為在第四季度，我們對供應有很好的可見性，並且有足夠的信心提高我們的銷售指導，這就是我們所做的。所以我們會在第四季度感受到這一點。我仍然認為我們會看到這種流動的環境，我們將繼續經歷一些更高的成本。我會告訴你，一旦我們解決了某種電子元件問題，我們就會收到一個 n-2 供應商就另一個問題與我們聯繫，所以我們感覺已經解決了——因為我們重新管理我們的供應鏈問題。

Great. And as we go into 2023, where I think everybody is starting to focus, I don't think there's much issue with the top line with 9.9% in the quarter, 8.5% to 9% for the year. That looks really good. I think people feel comfortable into next year. Where there's questions is down the P&L and on EPS. And Kevin, you mentioned the comment about strong EPS growth next year. I see The Street -- my numbers looks north of 50 basis points margin expansion. Next year, which might be a little high given the trends we're seeing here, would love to hear if you have any initial comments on thoughts on 2023 and particularly what that strong EPS growth means?

偉大的。隨著我們進入 2023 年，我認為每個人都開始關注，我認為本季度收入為 9.9%，全年為 8.5% 至 9% 的收入沒有太大問題。這看起來真的很好。我認為人們對明年感到很舒服。有問題的地方是損益表和每股收益。凱文，你提到了關於明年每股收益強勁增長的評論。我看到了華爾街——我的數據看起來超過了 50 個基點的利潤率擴張。明年，考慮到我們在這裡看到的趨勢，這可能有點高，如果您對 2023 年的想法有任何初步評論，特別是強勁的每股收益增長意味著什麼？

Yes. Thanks, Robbie. As you know, we're going to give specific guidance in January, as we always do. But I did make that comment in my opening remarks to signal that this year is an aberration. We will get back to strong earnings, which does absolutely imply margin expansion in 2023. But specifics, we'll get to you in January.

是的。謝謝，羅比。如您所知，我們將一如既往地在 1 月份提供具體指導。但我確實在我的開場白中發表了這樣的評論，以表明今年是反常的。我們將恢復強勁的收益，這絕對意味著 2023 年的利潤率會擴大。但具體情況，我們將在一月份與您聯繫。

Our next question comes from Lawrence Biegelsen with Wells Fargo.

我們的下一個問題來自富國銀行的勞倫斯·比格爾森。

I wanted to ask first about the supply shortages. Kevin or Glenn, I don't know if you are willing to comment on how much you think they impacted you. How much do you expect to be impacted in Q4? And are these sales you expect to get back over time? And I had one follow-up.

我想先問一下供應短缺的問題。凱文或格倫，我不知道你是否願意評論你認為他們對你的影響有多大。您預計第四季度會受到多大影響？這些銷售額是否會隨著時間的推移而恢復？我有一個跟進。

Yes. Larry, I think not to give specific guidance on numbers relative to the disruptions, but suffice to say that on some products, we are very hand-to-mouth in terms of how we're getting componentry to complete those products and ship them to customers. On some, we have a little bit better visibility.

是的。拉里，我認為不會就與中斷相關的數字給出具體指導，但我只想說，在某些產品上，我們在如何獲得組件來完成這些產品並將它們運送到顧客。在某些方面，我們有更好的能見度。

I would tell you that with our order backlog at an all-time high, we are seeing pretty significant disruptions across our capital businesses. We're very focused on getting product to customers. We know that's important. And we are working hard to make sure that as we can secure supply, that we work around the clock to get those products finished and get them out to customers.

我會告訴你，隨著我們的訂單積壓處於歷史最高水平，我們的資本業務出現了相當大的中斷。我們非常專注於為客戶提供產品。我們知道這很重要。我們正在努力確保在確保供應的同時，我們全天候工作以完成這些產品並將它們交付給客戶。

Yes. Larry, what I'd add is our problems are in the MedSurg side of our business. And on the MedSurg side of our business, we're not going to lose sales. So if we have problems in the implant side, those sales would be lost to competitors. In this case, customers are waiting. The products aren't urgent. We do have a plan to get these products to our customers.

是的。拉里，我要補充的是，我們的問題在於我們業務的 MedSurg 方面。在我們業務的 MedSurg 方面，我們不會失去銷售。因此，如果我們在植入物方面出現問題，這些銷售額就會輸給競爭對手。在這種情況下，客戶正在等待。產品不急。我們確實有計劃將這些產品提供給我們的客戶。

Medical's numbers, which were pretty impressive at 13-plus percent organic, would have been materially higher because of the emergency care demand, and the same with Instruments. Those are the 2 divisions that had the most impact. Frankly, we have a lot of niggling issues across our portfolio, but those 2 divisions were severely impacted in Q3. You'll see some recovery in Q4 and into next year. But I really don't expect to lose any of those sales, which gives me a lot of confidence going into next year that our positive sales trajectory will continue.

Medical 的數字在 13% 以上的有機數據中令人印象深刻，但由於緊急護理需求，該數據本來會更高，Instruments 也是如此。這些是影響最大的兩個部門。坦率地說，我們的產品組合中有很多瑣碎的問題，但這兩個部門在第三季度受到了嚴重影響。你會在第四季度和明年看到一些復甦。但我真的不希望失去任何這些銷售，這讓我對明年充滿信心，我們的積極銷售軌跡將繼續下去。

That's helpful. And then maybe a little bit more color on the softness with Mako this quarter. How confident are you in the rebound in Q4? And Glenn, I know the other line is not just Mako, but when can we expect to see that line turn positive?

這很有幫助。然後可能在本季度與 Mako 的柔軟度上增加一點色彩。您對第四季度的反彈有多大信心？還有格倫，我知道另一條線不只是 Mako，但是我們什麼時候可以看到這條線轉正呢？

Larry, it's Jason. I'll start here and talk a little bit about Mako. And then, Glenn, if you want to comment on the other piece, feel free. But as it relates to Mako, like I said in my prepared remarks, the orders were soft. But if you look at the order pipeline, it is very robust. And we continue to be, I'll say, the robotic-assisted choice in the marketplace. And so we feel good about Q4. And like I said in my prepared remarks, we expect a strong quarter.

拉里，我是傑森。我將從這裡開始，談談 Mako。然後，格倫，如果你想評論另一篇文章，請隨意。但正如我在準備好的評論中所說的那樣，與真子有關，命令是軟的。但是，如果您查看訂單管道，它非常健壯。我會說，我們仍然是市場上機器人輔助的選擇。所以我們對第四季度感覺很好。就像我在準備好的講話中所說的那樣，我們預計季度表現強勁。

Yes, Larry. The only thing I'd add is there are a couple of products in that line item, Other. But yes, you're right, that's where Mako is. I don't really want to guide you on Q4. I think sequentially, we will definitely see improvement. But in terms of when will we see full positivity, we'll talk about that in January.

是的，拉里。我唯一要補充的是，該行項目中有幾個產品，其他。但是，是的，你是對的，這就是 Mako 所在的地方。我真的不想在第四季度指導你。我認為依次，我們肯定會看到改進。但就我們何時會看到完全的積極性而言，我們將在一月份討論這個問題。

Yes. Just one last comment to add. What I'm really encouraged by is quarter after quarter after quarter, we're seeing the knee -- Mako as a percent of our total knees go up, hips as a percent of -- Mako Hips as a percent of total hips go up. Cementless percent of total knees go up, and cementless tends to correlate very well with Mako. So all of those metrics are heading the right direction. Yes, we've had some more delays in getting these robots installed and sold to our customers, but Q4 will be good and will continue our positive trajectory.

是的。只需添加最後一條評論。真正讓我感到鼓舞的是一個季度又一個季度，我們看到膝蓋——Mako 占我們總膝蓋的百分比上升，臀部百分比——Mako 臀部佔總臀部的百分比上升.非水泥佔全膝關節的百分比上升，非水泥與 Mako 的相關性非常好。因此，所有這些指標都朝著正確的方向發展。是的，我們在安裝這些機器人並將其出售給我們的客戶方面有一些延遲，但第四季度將會很好，並將繼續我們的積極軌跡。

(Operator Instructions) Our next question comes from the line of Vijay Kumar with Evercore ISI.

（操作員說明）我們的下一個問題來自與 Evercore ISI 的 Vijay Kumar。

Guys, congrats on a good top line print here. Kevin, maybe my first question here is on '23, I guess, did I hear you guys say labor situation improves, so that's a big tailwind in '23? And how should we think about this capital versus supply chain impact, those dynamics, right? Its strong capital order book versus supply chain dynamics, how does that impact '23? Any new products that we should be thinking of? Again, I'm not asking for specific guidance, but maybe some qualitative comments on these variables.

伙計們，恭喜這裡有一個很好的頂行打印。凱文，也許我在這裡的第一個問題是在 23 年，我猜，我有沒有聽到你們說勞動力狀況有所改善，所以這是 23 年的一個大順風？我們應該如何看待這種資本與供應鏈的影響，這些動態，對吧？其強大的資本訂單與供應鏈動態，這對 23 年有何影響？有什麼我們應該考慮的新產品嗎？同樣，我不是在要求具體的指導，而是可能對這些變量進行一些定性的評論。

Okay. Sure. I'll stay in the land of qualitative, Vijay, at this time of the year. But first, we are seeing a tailwind in procedural demand. So procedures are recovering around the world, a little slower in the Asia Pac regions. But given what happened with COVID, we expect that tailwind, as you saw, with very good growth in our Hip and Knee business, that will continue into fourth quarter, and I think a pretty modest or moderate tailwind in throughout 2023 and maybe even into 2024. So that's one positive tailwind.

好的。當然。每年的這個時候，我都會呆在質量維杰的土地上。但首先，我們看到了程序需求的順風。因此，世界各地的程序都在恢復，而亞太地區的速度要慢一些。但鑑於 COVID 發生的情況，我們預計，如您所見，我們的髖關節和膝關節業務增長非常好，這種順風將持續到第四季度，我認為整個 2023 年甚至可能會出現相當溫和或溫和的順風2024. 所以這是一個積極的順風。

We have a number of new products we're launching: System 9 camera in the early part of the year -- sorry, System 9 power tool in the early part of the year; [1780] camera around the middle of the year; and then we've got a defibrillator, which is a little less certain on timing because it's a PMA product, but the LIFEPAK perhaps towards the latter part of the year. But those are big, massive and important products.

我們有許多新產品要推出： 年初的 System 9 相機——對不起，年初的 System 9 電動工具； 【1780】年中左右相機；然後我們有一個除顫器，它在時間上不太確定，因為它是 PMA 產品，但 LIFEPAK 可能會在今年下半年推出。但這些都是巨大的、巨大的和重要的產品。

And you know what happens when we launch those products. I kind of call it a super cycle within MedSurg of new product launches. We have the Insignia Hip Stem, which is less than 50% of the way it launched. You know that these implant launches take multiple years to get all the sets out into the field, but tremendous momentum. You saw our Hip numbers have looked good the last couple of quarters relative to competition because of the Insignia stem, and that will just continue to gain steam going forward. So those are a number of the positives.

你知道當我們推出這些產品時會發生什麼。我把它稱為 MedSurg 中新產品發布的超級循環。我們有 Insignia Hip Stem，它的推出方式還不到 50%。您知道，這些植入物的推出需要多年時間才能將所有裝置投入該領域，但勢頭巨大。您看到我們的 Hip 數據在過去幾個季度相對於競爭對手來說看起來不錯，因為 Insignia 莖幹，這將繼續獲得動力。所以這些是一些積極的方面。

What I'd say on the order book side, that we know we have this big, big backlog of orders that customers are willing to wait for, in many cases, especially in emergency care. Orders are not being canceled. That gives us a lot of confidence that the demand is there. We just have to make sure we can get the supply to the customers. And we've been securing chips. We've been securing different products. But as Glenn mentioned, it's been hit and miss along -- sometimes it's just a resin, sometimes it's a small component. So there's been spottiness.

我在訂單方面要說的是，我們知道我們有大量客戶願意等待的訂單積壓，在許多情況下，尤其是在緊急護理方面。訂單不會被取消。這給了我們很大的信心，即需求是存在的。我們只需要確保我們可以為客戶提供供應。我們一直在保護芯片。我們一直在保護不同的產品。但正如格倫所提到的，它一直受到打擊 - 有時它只是一種樹脂，有時它是一個小部件。所以出現了斑點。

It's getting better, but it's kind of getting better slowly. So we'll fight our way through that probably in the first half of next year. But tremendous demand in the absence of new products, and those new products will just sort of give us extra momentum going into next year. I just picked a few. But -- sorry for some of my divisions. I didn't mention the hip, the shoulder, the foot & ankle. And so there's a lot of other ones, but those are sort of the -- some of the big ones.

它正在好轉，但它正在慢慢好轉。所以我們可能會在明年上半年努力解決這個問題。但是在沒有新產品的情況下存在巨大的需求，而這些新產品會給我們明年帶來額外的動力。我只挑了幾個。但是 - 對不起我的一些部門。我沒有提到臀部、肩膀、腳和腳踝。所以還有很多其他的，但這些都是 - 一些大的。

That's helpful color, Kevin. Glenn, maybe one for you. At current FX rates, how should we think about EPS impact for '23? And the 250 basis points of gross margin impact, what is being capitalized? What percentage of that 250 basis points is being capitalized on the balance sheet?

這是有用的顏色，凱文。格倫，也許給你一個。按照目前的匯率，我們應該如何看待 23 年每股收益的影響？以及 250 個基點的毛利率影響，什麼被資本化了？這 250 個基點中有多少百分比在資產負債表上被資本化？

Okay, Vijay. The -- on the FX rates, without overly guiding for next year, but I think if you look at sort of what happened in 2022, rates really took off in sort of Q3, Q4. And so the comparable for Q1, Q2, I still think will have a pretty big impact for rates next year as you look at sort of your modeling for next year.

好的，維杰。 - 關於外匯匯率，對明年沒有過度指導，但我認為如果你看看 2022 年發生的事情，匯率真的在第三季度和第四季度起飛。因此，當您查看明年的模型時，我仍然認為第一季度和第二季度的可比性將對明年的利率產生相當大的影響。

And then in terms of just the capitalized variance piece, we -- I won't give you specifics. But I will remind you that to the extent we are making spot buys, it relates to raw materials that gets put in inventory, and then the future utilization of those raw materials is usually over an 8- to 9-month time frame. So that gets a little bit more -- to Kevin's comment, that we'll still feel some of this into -- well into Q2 of next year. And to the extent we're still in a spot-buy-premium situation in Q1 of 2023, then that will bleed into, say, Q3 as well.

然後就大寫的差異部分而言，我們 - 我不會給你細節。但我要提醒您，就我們進行現貨採購而言，它與庫存的原材料有關，然後這些原材料的未來利用通常超過 8 到 9 個月的時間範圍。所以這會得到更多 - 根據凱文的評論，我們仍然會感受到其中的一些 - 直到明年第二季度。如果我們在 2023 年第一季度仍處於現貨買入溢價的情況下，那麼這也將滲透到第三季度。

Our next question comes from Pito Chickering with Deutsche Bank.

我們的下一個問題來自德意志銀行的 Pito Chickering。

The first one is messaging has been very consistent throughout this year about the strong capital demand. And I understand that there's a give and take between backlog of orders, because there's orders to fill, orders canceled and new orders. So I guess, can you talk specifically on new orders during 3Q and what you're seeing for 4Q against your expectations?

第一個是關於強勁資本需求的信息在今年全年非常一致。而且我知道在積壓的訂單之間存在相互讓步，因為有訂單要填寫，訂單取消和新訂單。所以我想，您能否具體談談第三季度的新訂單以及您在第四季度看到的與您的預期相反的情況？

Yes. Pito, it's Jason. I'll jump in here. I would point you back to some of the commentary around the order book. And if you look at our capital businesses, it continues to be very strong. And so as we look to the fourth quarter, similar to the comments Kevin said around Medical and Instruments, we certainly expect a recovery in the fourth quarter with Instruments and another strong quarter for Medical as well.

是的。皮托，是傑森。我會跳到這裡。我會向您指出有關訂單簿的一些評論。如果你看看我們的資本業務，它仍然非常強大。因此，當我們展望第四季度時，類似於凱文在醫療和儀器方面所說的評論，我們當然預計第四季度儀器的複蘇以及醫療的另一個強勁季度。

And even Endoscopy, who had a very strong Q3, they grew their orders as well in the quarter. So they will also have another strong quarter in Q4. So it's really across our portfolio where the demand is very, very strong. And we're not seeing sort of a capital slowdown, which I know I've heard out that some other companies mentioned. We're just not seeing that in our orders. We're not having orders canceled.

即使是第三季度表現非常強勁的內窺鏡檢查，他們在本季度的訂單也有所增長。因此，他們在第四季度也將迎來另一個強勁的季度。因此，在我們的投資組合中，需求非常非常強勁。而且我們沒有看到資本放緩，我知道我聽說過其他一些公司提到過。我們只是沒有在我們的訂單中看到這一點。我們沒有取消訂單。

It's kind of -- it's something I haven't seen in my tenures here of customers ordering things and then canceling it. So we feel very good about our position. Orders have not slowed down. They just continue to grow. Just one little example, which I really enjoy, is on Vocera, we've now integrated that with our ProCuity bed. So the alerts for falls from the bed actually goes straight to the badge, and we're already showing this to our customers and getting really wild, positive feedback from customers on this.

有點——這是我在這裡任職期間從未見過的客戶訂購東西然後取消它的情況。所以我們對自己的位置感覺很好。訂單並未放緩。他們只是繼續成長。我非常喜歡的一個小例子是在 Vocera 上，我們現在已經將它與我們的 ProCuity 床集成在一起。因此，從床上跌倒的警報實際上直接進入了徽章，我們已經向我們的客戶展示了這一點，並從客戶那裡獲得了非常瘋狂的積極反饋。

And again, it's early days, but the ProCuity momentum, which really powered our strong Medical growth this quarter, is just building. And it's kind of the second year of the launch. It's really just gaining steam. And now with its interoperability with Vocera, that provides an extra bit of energy to that business.

再說一次，現在還處於早期階段，但真正推動我們本季度強勁的醫療增長的 ProCuity 勢頭正在形成。這是發布的第二年。它真的只是獲得蒸汽。現在，它與 Vocera 的互操作性為該業務提供了額外的能量。

Okay. Fair enough. And then a follow-up on Neurovascular is a touch weaker this quarter. Just curious, how is that market versus competition versus supply shortages?

好的。很公平。然後本季度對神經血管的後續行動有所減弱。只是好奇，市場與競爭與供應短缺之間的關係如何？

Yes. Thanks. We've seen a slow market this year in the U.S. in Neurovascular, not exactly sure why. There's a number of different theories out there as to why the market itself has been slow. I'd say that's probably most of it. But there are new competitors in both aspiration as well stent retrievers. The FDA has kind of reduced the requirements, the clinical requirements in those categories. So there are a number of new players, which affects part of it.

是的。謝謝。今年我們在美國看到了神經血管市場緩慢，不完全確定原因。關於市場本身為何緩慢，有許多不同的理論。我會說這可能是大部分。但在抽吸和支架回收器中都有新的競爭對手。 FDA 已經降低了這些類別的要求，即臨床要求。所以有很多新玩家，影響了一部分。

But the market has been soft. And maybe it's a COVID issue that some of these patients that would have had strokes are not having strokes because of the mortality effects of COVID. It's hard to know exactly why, but the market has slowed down definitely in the U.S. I think that's probably the bigger portion, but there are also some competitive pressures.

但市場一直疲軟。也許這是一個 COVID 問題，因為 COVID 對死亡率的影響，其中一些本來會中風的患者沒有中風。很難確切知道原因，但美國的市場確實放緩了。我認為這可能是更大的部分，但也存在一些競爭壓力。

Keep in mind that for us, the U.S. is much smaller than our OUS business in Neurovascular, has always been that way. It's the one business that kind of has the reverse of the rest of our portfolio. So we continue to feel bullish about the long-term prospects on this business. We're only treating a small percentage of people that have strokes. And as I noted in my opening remarks, we've just completed -- signed an agreement for a tuck-in acquisition in the [intraocular] space.

請記住，對我們來說，美國的規模遠小於我們在神經血管領域的 OUS 業務，一直如此。這是一項與我們其他投資組合相反的業務。因此，我們繼續看好該業務的長期前景。我們只治療一小部分中風患者。正如我在開場白中指出的那樣，我們剛剛完成了 - 簽署了一項在 [眼內] 空間進行折疊收購的協議。

Our next question comes from the line of Matthew O'Brien with Piper Sandler.

我們的下一個問題來自 Matthew O'Brien 和 Piper Sandler。

The first one is just on the restructuring you talked about. Is that something that's going to be impactful to next year, specifically to help drive that at EPS growth? And then do you have other levers that are kind of below the line that you can pull on to help with the EPS growth for next year?

第一個是關於你談到的重組。這是否會對明年產生影響，特別是有助於推動每股收益增長？然後，您是否還有其他低於底線的槓桿可以幫助您實現明年的每股收益增長？

Well, EPS growth, as I mentioned, there'll be a combination of price. And in fact, some businesses are taking on their second round of price increases. And having the timing of those start to really appear as contracts roll off. So price is one component. Cost reduction clearly is another component.

好吧，正如我所提到的，每股收益的增長將是價格的結合。事實上，一些企業正在進行第二輪漲價。並且隨著合同的到期，這些時間開始真正出現。所以價格是一個組成部分。降低成本顯然是另一個組成部分。

The restructuring, these actions are very targeted. So it's really around things we were going to do anyways to improve our processes. We're just accelerating those activities. We'll see some of that this year. We'll see some of that into early part of next year, and it will have an impact in our earnings per share, for sure, next year.

這次改制，這些動作很有針對性。所以這實際上是圍繞著我們無論如何都要做的事情來改進我們的流程。我們只是在加速這些活動。我們將在今年看到其中的一些。我們將在明年年初看到其中的一些，它肯定會在明年對我們的每股收益產生影響。

And Matt, below the line, if you look at sort of OI&E in taxes, it's -- there are some opportunities related to how quickly we pay down the term loan. So there could be some pickups relative to interest expense, although those would be minor given the rates. And then taxes is -- I don't expect any surprises, sort of steady as we've been there.

馬特，在下面，如果你看一下稅收中的 OI&E，它是 - 有一些機會與我們償還定期貸款的速度有關。因此，相對於利息支出可能會有一些回升，儘管考慮到利率，這些回升幅度很小。然後稅收是 - 我不希望有任何驚喜，就像我們一直在那裡一樣穩定。

Okay. And then, Kevin, on Mako with the new -- sorry, go ahead.

好的。然後，凱文，關於 Mako 和新的——對不起，繼續。

I was going to say one last comment before. We will get mix benefits from the new products that we launched. So that's one thing to -- and you won't see that in the price line, but we'll definitely get that benefit through the P&L, which helps our earnings.

我之前要說最後一條評論。我們將從我們推出的新產品中獲得混合收益。所以這是一回事 - 你不會在價格線上看到這一點，但我們肯定會通過損益表獲得這種好處，這有助於我們的收益。

Okay. Okay. And then, Kevin, I think back to the Analyst Day maybe 1.5 years ago, you talked about Mako with these new indications of shoulder and spine kind of coming out, I think, more a step -- like having one 1 year then one the following year. Is this now commentary about these 2 coming out at the same time because maybe spine is getting pushed a little bit later than you expected before? And I didn't hear you specifically say spine and shoulder for Mako next year. So is this something we should expect more like '24 and beyond?

好的。好的。然後，凱文，我想回想起大概 1.5 年前的分析師日，你談到了 Mako，肩部和脊柱的這些新跡像出現了，我認為，更像是一個步驟 - 就像有一個 1 年然後一個下一年。現在這是關於這兩個同時出現的評論，因為也許脊椎被推得比你以前預期的要晚一點嗎？而且我沒有聽到你特別提到明年 Mako 的脊椎和肩膀。那麼這是我們應該期待的更像 24 年及以後的事情嗎？

Yes. You know what, we're not ready to give you a time line now. I wouldn't expect it next year. But in one of the next upcoming calls, perhaps January or the one after that, we will give you some expected time lines. The reason that they're coming out at the same time now, there's 2 things. One is Spine's kind of moved ahead in its pace, and Shoulder kind of moved back a little bit because we had to adapt to the Tornier implants and bring in the Blueprint software and marry that with Mako.

是的。你知道嗎，我們現在還沒準備好給你一個時間表。我沒想到明年。但在下一次即將召開的電話會議中，可能是一月份或之後的電話會議，我們將為您提供一些預期的時間線。他們現在同時出來的原因有兩點。一個是 Spine 的步伐有點領先，而 Shoulder 有點後退，因為我們必須適應 Tornier 植入物並引入 Blueprint 軟件並將其與 Mako 結合。

So we were on a certain time line with Stryker shoulder implants, but we wanted to switch to the Tornier implants. They're the market-leading implants. So we had to sort of delay that one. But Spine has been moved forward. So the team has done a terrific job. We had 2 projects that we're pursuing: the Cardan one as well as Mako. Mako is going to be the answer for us. We've already started to show some surgeons, and we've received very, very positive feedback on that.

所以我們在一定的時間線上使用 Stryker 肩部植入物，但我們想改用 Tornier 植入物。它們是市場領先的植入物。所以我們不得不推遲那個。但是Spine已經向前推進了。所以團隊做得非常好。我們有 2 個正在追求的項目：Cardan 和 Mako。 Mako 將成為我們的答案。我們已經開始展示一些外科醫生，並且我們收到了非常非常積極的反饋。

So we're excited. And so again, the timing, hopefully, possibly as early as January, I'll give you more specifics on it. As you know, robots are complicated. That's why we're sort of hesitant to first give you time lines until we feel more confident. But I'd say that a lot of the challenges that we had before, we've overcome. And we've had good meetings with the FDA. We're on a very good trajectory on both of those projects. Hard for me actually to know which one will be first. They'll come out pretty -- in pretty close proximity to each other.

所以我們很興奮。再說一次，時間安排，希望最早可能在一月份，我會給你更多的細節。如您所知，機器人很複雜。這就是為什麼我們有點猶豫是否首先給你時間線，直到我們感到更有信心。但我想說，我們之前遇到的很多挑戰，我們已經克服了。我們與 FDA 進行了良好的會議。我們在這兩個項目上都處於非常好的軌道上。我真的很難知道哪個會是第一個。他們會很漂亮 - 彼此非常接近。

Our next question comes from the line of Joshua T. Jennings with Cowen.

我們的下一個問題來自 Joshua T. Jennings 和 Cowen 的對話。

I wanted to start just on pricing. It sounds like guys are getting some traction there on your pricing initiatives. Should we be thinking about price turning positive? I think it's 70 basis points headwind in 3Q. Or is that too aggressive? Just wanted to get a better sense.

我想從定價開始。聽起來人們對你的定價計劃有了一些吸引力。我們應該考慮價格轉正嗎？我認為第三季度有 70 個基點的逆風。還是太激進了？只是想獲得更好的感覺。

And the follow-up question is just on just the ASCs with your ortho business, but primarily joints. Any updates just in terms of receptivity for Mako robots? And also just the pace of ASCs opening, and that seems to be maybe the bottleneck in terms of the pace of migration overall orthopedic procedures into ASCs. But wanted to just get a better sense of what you're seeing in ASCs as well?

後續問題僅針對您的正畸業務的 ASC，但主要是關節。僅在 Mako 機器人的接受度方面有任何更新嗎？還有 ASC 開放的速度，這似乎是整個骨科手術向 ASC 遷移速度的瓶頸。但是也想更好地了解您在 ASC 中看到的內容嗎？

Josh, it's Glenn. I'll take the first one on pricing. I think, first of all, we're having obviously some big initiatives going on around pricing, making sure that we're educating customers in terms of what's happening to us relative to the cost of raw materials and things like that. Pricing is mostly impacting MedSurg. That's not to say there's not as big of impact on the ortho side.

喬希，是格倫。我將採取第一個定價。我認為，首先，我們顯然在定價方面採取了一些重大舉措，確保我們正在教育客戶了解我們正在發生的事情與原材料成本和類似的事情有關。定價主要影響 MedSurg。這並不是說對正方的影響沒有那麼大。

Keep in mind, too, that most of our businesses are under some sort of contracts. And so a lot of this sort of pacing is relative to as those contracts come up for negotiation, we can enter into that with those customers. I think so far, we're seeing good progress. We expect to continue to see good progress into Q4.

請記住，我們的大多數業務都簽訂了某種合同。因此，很多這種節奏都與這些合同進行談判時有關，我們可以與這些客戶進行談判。我認為到目前為止，我們看到了良好的進展。我們預計第四季度將繼續取得良好進展。

I won't call out a guide yet for next year. But what I would tell you, one of the things that also will give us a little bit of lift that may not be reflected in pricing is the comment that Kevin made relative to new products that are released. And most new products that are released are released at a premium price relative to the legacy price. And so that will give us a little bit of uplift as well.

明年我不會叫指南。但我要告訴你的是，可能不會反映在定價中的一件事也會給我們帶來一點提升，那就是凱文相對於已發布的新產品所做的評論。並且大多數發布的新產品都以相對於舊價格的溢價發布。所以這也會給我們帶來一點提升。

Okay. And related to your question on ASCs, we -- our offense continues to exceed our expectation. Just the bundle that we provide for the ASC to make life easy for them has been very well received. Close to half of the deals that we win includes a Mako in these orthopedic ASCs. We've now crossed sort of the 10% mark of large joints that are done in ASCs.

好的。關於你關於 ASC 的問題，我們——我們的進攻繼續超出我們的預期。只是我們為 ASC 提供的讓他們的生活更輕鬆的捆綁包已經非常受歡迎。我們贏得的近一半交易包括這些骨科 ASC 中的 Mako。我們現在已經超過了在 ASC 中完成的大關節的 10%。

It keeps going up, not at a rapid rate, but it's a steady climb. And to your point, the gating factor is just construction and refurbishment of these ASCs to enable more procedures. But every hospital system I talked to is preparing themselves for another -- a new ASC. It's a trend that had started prior to COVID and has accelerated. And we expect that, that will continue.

它一直在上升，不是快速上升，而是穩步上升。就您而言，關鍵因素只是這些 ASC 的建造和翻新，以啟用更多程序。但我與之交談的每個醫院系統都在為另一個醫院系統做準備——一個新的 ASC。這是一種在 COVID 之前就已經開始並加速的趨勢。我們預計，這種情況將繼續下去。

But we love our position. The breadth of our portfolio, having capital, disposables and implants puts us in a really leading position. And Mako's, as I said, almost half the time are included, and that gives us a giant advantage.

但我們喜歡我們的職位。我們投資組合的廣度，擁有資本、一次性用品和植入物，使我們處於真正的領先地位。正如我所說，Mako 幾乎有一半的時間都包含在內，這給了我們巨大的優勢。

Our next question comes from the line of Matt Miksic with Barclays.

我們的下一個問題來自巴克萊銀行的 Matt Miksic。

A lot of great color as been covered here. But I'd first just love to see the interoperability and connected care comments around Vocera and just color around Mako for spine and shoulders is exciting. I wanted to just maybe focus a little bit back to margins on some of the purchasing comments you made, Glenn. And just to get a feel for how much of what impacted you in the third quarter had to do with spot buys purchases made in previous quarters. And whether any -- I think you mentioned that some of those prices are getting a little bit easier, which -- or better maybe, which then -- is that -- have we hit a high watermark in terms of the sort of impact on margins or is it too early to say? And I had one follow-up.

這裡介紹了很多很棒的顏色。但我首先很想看看 Vocera 周圍的互操作性和相互關聯的護理評論，而 Mako 周圍的脊椎和肩膀的顏色令人興奮。格倫，我想把注意力集中在你所做的一些購買評論上。並且只是為了了解第三季度對您的影響有多大與前幾個季度的現貨購買有關。是否有任何-我認為您提到其中一些價格變得更容易了，或者更好，然後-那就是-我們在影響方面是否達到了高水位利潤還是現在說還為時過早？我有一個跟進。

Okay. Yes, Matt, I think -- I mean a couple of things. As you sort of think about the guidance, the 250 basis points, in rough terms, half of that is being driven by sort of the premiums that we're paying on those spot buy purchases. And then the other half is really kind of solidly grounded in what we're seeing on the inflation and the inefficiency side, somewhat tempered by sort of some cost discipline, even within our operations.

好的。是的，馬特，我想——我的意思是幾件事。當您考慮指導時，粗略地說，250 個基點，其中一半是由我們為這些現貨購買購買支付的溢價推動的。然後另一半確實基於我們在通貨膨脹和低效率方面看到的情況，甚至在我們的運營中也受到某種成本紀律的影響。

On the spot buys, I think what I was saying is that we have better visibility now to our ability to acquire supply. We are seeing some moderation, although not as much as I think we were hoping to see, as we entered into Q3 in terms of what those costs are. So things are just -- they're not coming down as quick as we wanted them to, nor do I expect that our spot purchases in Q4 will come down significantly either.

現場購買，我想我說的是我們現在對我們獲得供應的能力有了更好的了解。我們看到了一些緩和，儘管沒有我認為我們希望看到的那麼多，因為我們進入第三季度時就這些成本而言。所以事情只是——它們並沒有像我們希望的那樣迅速下降，我也不認為我們在第四季度的現貨購買量也會大幅下降。

And then on the inflation side, a lot of that is flowing through increases in labor, increases in commodity prices that we're paying. Because we're in this difficult supply chain situation, we're having to use a lot of, say, airfreight versus ocean freight, which cost a lot more, to expedite raw materials coming in so that we can manufacture and get out to customers. And so those are the type of inflationary things that we're feeling that are in that number.

然後在通貨膨脹方面，其中很大一部分來自勞動力的增加，我們支付的商品價格的上漲。因為我們處於這種困難的供應鏈情況，我們不得不使用很多，比如空運而不是海運，成本要高得多，以加快原材料的進入，以便我們可以製造並交付給客戶.所以這些就是我們感覺到的通貨膨脹的類型。

Got it. That's helpful. And then maybe just one of the dynamics, Q3 to Q4, you mentioned that product mix was a bit of a headwind for you in Q3. Maybe if you could highlight some of the ways in which -- if you expect that to improve in Q4 or Q1. And around that, in particular, it seems like your businesses are sort of seeing a better look from some of the staffing challenges in hospitals than some other companies. And not everyone is seeing improvement.

知道了。這很有幫助。然後可能只是第三季度到第四季度的動態之一，您提到產品組合在第三季度對您來說有點不利。也許如果你能強調一些方式——如果你希望在第四季度或第一季度有所改善。尤其是圍繞這一點，與其他公司相比，您的企業似乎從醫院的一些人員配備挑戰中看到了更好的面貌。並不是每個人都看到了改善。

So just wondering how you think about what you're seeing in priorities of needs versus other procedures. Any color that you're getting that would kind of help folks understand what exactly is happening, what's happening and how it's maybe unevenly affecting different procedures in different settings?

所以只是想知道您如何看待您在需求優先級與其他程序中看到的內容。你得到的任何顏色都可以幫助人們了解到底發生了什麼，正在發生什麼以及它如何不均勻地影響不同環境中的不同程序？

Okay. Let me take the first part of that question relative to mix and what we saw in Q3 and how we think that might play out in Q4. I think you can sort of look at sort of sales growth as a proxy for where we felt the pain of mix. Instruments was down, and that's a fairly highly profitable business for us. NV was also a little bit down, and that too is a highly profitable business for us.

好的。讓我談談與混合有關的問題的第一部分，以及我們在第三季度看到的情況以及我們認為第四季度可能會如何發展。我認為您可以將某種銷售增長視為我們感受到混合痛苦的代表。 Instruments 倒閉了，這對我們來說是一項相當高利潤的業務。 NV 也有一點下降，這對我們來說也是一項高利潤的業務。

And so those not being a normal proportion of our sales really sort of hurt us somewhat at the margin line. I think Instruments has good visibility to supply moving into Q4, and so I do expect that we'll see a good performance out of Instruments as we wrap up the year. NV, it's a little bit different. It's not capital and there's not sort of a backlog of orders. NV is very procedural-based. But I know that NV is very focused on finishing out the year and hitting their quotas. And so I think we'll see some improvement out of NV as well.

因此，那些不在我們銷售額中的正常比例確實在一定程度上傷害了我們。我認為 Instruments 對進入第四季度的供應有很好的可見性，因此我確實希望在今年結束時我們會看到 Instruments 的良好表現。 NV，有點不一樣。這不是資本，也沒有訂單積壓。 NV 非常基於程序。但我知道 NV 非常專注於完成這一年並達到他們的配額。所以我認為我們也會看到 NV 的一些改進。

Yes. Just last point on mix. I think Australia is one of the big, big markets for Stryker. And they've been hit by COVID and delays, and they do expect a stronger -- it's already started. We're seeing that start to build, and that's a highly profitable business as well. So those are -- that's another element of mix we're going to see improve in Q4 versus Q3.

是的。只是混合的最後一點。我認為澳大利亞是 Stryker 的大市場之一。他們已經受到 COVID 和延誤的打擊，他們確實期望更強大——它已經開始了。我們看到它開始建立起來，這也是一項高利潤的業務。所以這些是 - 這是我們將在第四季度看到與第三季度相比有所改善的另一個混合元素。

And then your other question, I'm not sure I totally got it, but I think you were talking about different procedures and how we're seeing the recovery. And clearly, hip and knees, we're seeing robust recovery. There's big waiting lists, which in the U.K. and physicians who took -- maybe took some time off in summer a little bit more than they normally would given coming off the COVID are very busy now, and they're starting to operate more. As much staff is available for them, the more they're going to operate. And staffing is still a little bit challenged, but it's been gradually improving.

然後你的另一個問題，我不確定我是否完全明白，但我認為你在談論不同的程序以及我們如何看待恢復。很明顯，臀部和膝蓋，我們看到了強勁的恢復。在英國有很多等候名單，而那些在夏天休假的醫生——可能比他們通常因 COVID-19 而休假的時間多一點，現在非常忙，他們開始更多地工作。為他們提供的工作人員越多，他們的工作就越多。人員配備仍然有點挑戰，但它正在逐漸改善。

So there, we see robust kind of growth going into next year. Spine has been a little bit more choppy, to be honest. And I don't think it went down as much as hip and knees did. If you look at the Omicron variant and everything that -- spine procedures were still a little bit more resilient. And so we're not seeing that pop quite at the same extent as we are in our hip and knee.

因此，我們看到明年將出現強勁的增長。老實說，脊柱有點波濤洶湧。而且我認為它沒有像臀部和膝蓋那樣下降。如果你看一下 Omicron 變體和所有這些 - 脊柱手術仍然更有彈性。所以我們沒有看到與我們的臀部和膝蓋相同程度的流行音樂。

And I mentioned already Neurovascular in the U.S. where the market is soft, and that's the one that -- I saw some comments related to TAVR that talked about the market being a little bit soft. And I wonder if that patient profile with all these comorbidities, there might be something similar that could be impacting the ischemic stroke portion of the market. So that, hopefully, answered that part of your question.

我已經提到美國的神經血管市場疲軟，這就是——我看到一些與 TAVR 相關的評論說市場有點疲軟。我想知道所有這些合併症的患者檔案是否可能存在類似的東西，可能會影響市場的缺血性中風部分。因此，希望能回答您問題的這一部分。

Our next question comes from the line of Rick Wise with Stifel.

我們的下一個問題來自 Rick Wise 和 Stifel。

Kevin, 2 questions for me. First, we've touched on it a little bit, but you talked about Asia Pacific being -- continuing to be volatile, and China negative growth and that those pressures continuing through the end of '22. Just in general, at a high level, are you -- what's the setup for next year? Are you assuming, as you look at the landscape, that things are going to get better? Just, again, your high-level thoughts there?

凱文，我有 2 個問題。首先，我們已經談到了一點，但你談到亞太地區——繼續動盪，中國出現負增長，這些壓力一直持續到 22 年底。總的來說，在高層次上，你 - 明年的設置是什麼？當你看著風景時，你是否假設事情會變得更好？只是，再一次，你的高層想法在那裡？

Sure. Sure. At a high level, COVID has had a delayed impact in a lot of Asia Pacific. And we certainly expect it to get better. We're already seeing it. Japan had a really nice quarter this quarter. Australia will pick up in Q4. Some of the ASEAN countries are improving. So I do expect the outlook to be better next year in Asia Pacific overall than this year.

當然。當然。在較高的層面上，COVID 在亞太地區的許多地區產生了延遲影響。我們當然希望它會變得更好。我們已經看到了。日本本季度的表現非常好。澳大利亞將在第四季度回升。一些東盟國家正在改善。因此，我確實預計明年亞太地區的整體前景將好於今年。

Our emerging markets had really robust double-digit growth in spite of China being slightly negative. It was negative, really driven by volume-based procurement in the orthopedic side of our business, and pretty good performance on the MedSurg and Neurotechnology side of the business. But we, finally, after many years, started to build tremendous momentum in Latin America as well as emerging Europe, at least in Africa, where we're gaining really tremendous momentum with -- really driven by Mako as well as our 1688 camera. That's driving really strong growth this year. And I think that should continue going into next year.

儘管中國略有負增長，但我們的新興市場確實實現了兩位數的強勁增長。這是負面的，實際上是由我們業務骨科方面的基於數量的採購推動的，以及業務的 MedSurg 和神經技術方面的良好表現。但是，經過多年的努力，我們終於開始在拉丁美洲和新興歐洲建立巨大的勢頭，至少在非洲，我們在非洲獲得了巨大的勢頭——真正由 Mako 和我們的 1688 相機推動。這推動了今年的強勁增長。我認為這應該會持續到明年。

Even India has really had a terrific year this year. And as you know, we've had our share of challenges in the past. So I would say the international story for Stryker is starting to click. As you saw since 2019, our international organic growth has outpaced the U.S., and that did not happen in my first 7 years as CEO. And I do expect that to continue. And frankly, the COVID tailwind should really cement that going forward.

就連印度今年也確實過得很好。如您所知，我們過去也遇到過挑戰。因此，我想說 Stryker 的國際故事開始受到關注。正如您所看到的，自 2019 年以來，我們的國際有機增長已經超過了美國，而這在我擔任首席執行官的頭 7 年中並沒有發生。我確實希望這種情況繼續下去。坦率地說，COVID 的順風應該真正鞏固了這一點。

Great. And one other sort of big-picture question, Kevin. I mean you usually have great perspectives on this kind of stuff. One of the toughest questions to answer for me is how, when, where do some of these supply chain issues, particularly around chips, how does it get resolved? When does it get resolved?

偉大的。還有另一種大問題，凱文。我的意思是你通常對這類東西有很好的看法。對我來說最難回答的問題之一是，這些供應鏈問題中的一些問題，尤其是芯片問題，是如何、何時、何地解決的？什麼時候解決？

And I'd be curious to hear what you're thinking for the industry. But what are you thinking -- how are you going to resolve this so that you can stop worrying about it for Stryker? Is it just you just have to wait? Or are there tangible steps that you can take or the industry needs to take still to get past this topic?

我很想知道你對這個行業的看法。但是你在想什麼——你將如何解決這個問題，這樣你就可以不再為 Stryker 擔心了？只是你只需要等待嗎？還是您可以採取切實可行的步驟或行業仍需要採取措施來解決這個問題？

Yes. Look, it's a great question. I would tell you, this year has been extremely frustrating, unlike any year I've had where, to be honest, we misestimated. We thought early on, we were going to have 100 to 200 basis points of pressure. And now Glenn is saying it's 250. So that's something we did not call. It's been difficult to predict.

是的。看，這是一個很好的問題。我會告訴你，今年非常令人沮喪，與我所經歷的任何一年不同，說實話，我們錯誤估計了。我們很早就認為，我們將承受 100 到 200 個基點的壓力。現在 Glenn 說是 250。所以這不是我們所說的。很難預測。

I think one of the steps that we're taking, which is really kind of exciting, is as you move to new products, so as we move to System 9 and as we move to 1788, we're using new-generation chips. And the supply availability is actually quite high for new-generation chips. And so the faster we can migrate to new products, it actually helps secure our ability to have supply.

我認為我們正在採取的步驟之一，這真的有點令人興奮，那就是當你轉向新產品時，當我們轉向 System 9 和轉向 1788 時，我們正在使用新一代芯片。而新一代芯片的供應量實際上是相當高的。因此，我們越快遷移到新產品，它實際上有助於確保我們的供應能力。

And so we are pushing our R&D teams really hard to be able to shift to these newer products. Because our challenge is, frankly, the older-generation chips. And that's why emergency care is so pressured, emergency care being defibrillators primarily, because their PMA products, we can't just swap the chip out. It goes through a whole regulatory regime, and those are older-generation chips. So the faster we can migrate to new products, the faster that secures our chip availability.

因此，我們非常努力地推動我們的研發團隊能夠轉向這些新產品。因為坦率地說，我們面臨的挑戰是老一代芯片。這就是為什麼急救護理壓力如此之大，急救護理主要是除顫器，因為他們的 PMA 產品，我們不能只是換掉芯片。它經歷了一個完整的監管制度，這些都是老一代芯片。因此，我們遷移到新產品的速度越快，確保我們的芯片可用性的速度就越快。

It's been kind of a moving target. As we secure chips with one supplier, we have a new problem with another supplier. And even things like resins. And so it's been a very unusual and tough year, but it's slowly getting better, Rick. And as we launch new products, that will get us really healthy because new chips aren't the problem. Our problem is really getting the old electronics.

這是一個移動的目標。當我們與一個供應商確保芯片安全時，我們又遇到了另一個供應商的新問題。甚至樹脂之類的東西。所以這是非常不尋常和艱難的一年，但它正在慢慢變得更好，瑞克。當我們推出新產品時，這將使我們非常健康，因為新芯片不是問題。我們的問題是真的得到舊的電子產品。

And frankly, the camera business, I give our Endoscopy team a lot of credit that they were able to actually qualify some new products. And because it's not PMA, they were able to really drive good growth, but it's been a scramble. And we're hopeful that things get stable. Really, I think we're going to be in this soup for probably another couple of quarters by the middle of the year. And then I think skies will start to clear.

坦率地說，在相機業務方面，我非常感謝我們的內窺鏡團隊，因為他們能夠真正鑑定出一些新產品。而且因為它不是 PMA，所以他們能夠真正推動良好的增長，但這是一場爭奪戰。我們希望事情能穩定下來。真的，我認為到今年年中，我們可能還要再堅持幾個季度。然後我認為天空會開始晴朗。

But you know what, that's -- I don't have a total crystal ball, and we haven't been right this year. But that's sort of how it looks right now, that they'll still be a little choppy, but it's just moderately getting better as we go through the year.

但你知道嗎，那是——我沒有一個完全的水晶球，今年我們做得不對。但這就是現在的樣子，它們仍然會有點波濤洶湧，但隨著我們這一年的過去，情況正在適度好轉。

Next question comes from Drew Ranieri with Morgan Stanley.

下一個問題來自摩根士丹利的 Drew Ranieri。

Kevin and Glenn, just maybe, Kevin, on your comments about ProCuity, the bed launch, you're gaining momentum there and it's in your second year of launch. Just kind of curious how the launch is progressing. And if you could give us an update on where you are in terms of market share, the replacement cycle. And then really, what should we expect now that you have integrated Vocera into the ProCuity bed? Should that have a meaningful acceleration into the ProCuity launch?

凱文和格倫，也許，凱文，關於你對 ProCuity 的評論，床發布，你在那裡獲得了動力，這是你發布的第二年。只是有點好奇發射進展如何。如果你能告訴我們你在市場份額方面的最新情況，更換週期。然後真的，既然您已將 Vocera 集成到 ProCuity 床中，我們應該期待什麼？這是否應該對 ProCuity 的發布產生有意義的加速？

Yes. I'm very bullish on ProCuity. It's a fantastic product, and the cross-sell capability with Vocera, where we were strong, let's say, with ProCuity or beds and Vocera wasn't as strong for Vocera. Conversely, Vocera was strong, but we didn't have a strong bed position. That cross-sell opportunity is already presenting itself. We've been in front of some very big accounts, and we're showing them this integrated system. And we've already gotten some orders. And so I'm bullish. It had a terrific third quarter. We're trying to make them as fast as we can right now, which is a high-class problem. And so I think you're going to see very good results for ProCuity. It's a winning bed, and Vocera is just going to add gas to the fire.

是的。我非常看好 ProCuity。這是一個了不起的產品，並且與 Vocera 的交叉銷售能力，比方說，我們在 ProCuity 或床方面很強大，而 Vocera 對 Vocera 來說沒有那麼強大。相反，Vocera 很強壯，但我們沒有穩固的床位。這種交叉銷售機會已經出現了。我們已經在一些非常大的客戶面前，我們正在向他們展示這個集成系統。我們已經接到了一些訂單。所以我看好。它有一個了不起的第三季度。我們現在正試圖盡可能快地製造它們，這是一個高級問題。所以我認為你會看到 ProCuity 的結果非常好。這是一張成功的床，而 Vocera 只是要火上澆油。

And Glenn, maybe one for you, but I know you don't necessarily want to give '23 guidance at all. But just as you're thinking about free cash flow and Kevin's comments about strong EPS growth for next year, can you help us contextualize that on maybe what free cash flow growth we should see for next year or working capital improvements?

還有格倫，也許是給你的，但我知道你根本不想給 23 歲的指導。但是，正如您正在考慮自由現金流和凱文關於明年強勁每股收益增長的評論一樣，您能否幫助我們將其背景化到明年我們應該看到什麼樣的自由現金流增長或營運資本改善？

Yes. I think right now, just given all the variability in kind of where we are, we're just focused on this year and finishing up, I'd hate to throw out a number for free cash flow conversion. I think it would be safe to assume that it wouldn't be far away from our historical averages, and that's probably where we would land for next year. Keep in mind, for next year, our focus will still be debt repayment. And we'll pay down the rest of that term loan before we allocate other capital to M&A.

是的。我認為現在，考慮到我們所處位置的所有可變性，我們只關註今年並結束，我不想拋出一個自由現金流轉換的數字。我認為可以安全地假設它不會遠離我們的歷史平均水平，這可能是我們明年登陸的地方。請記住，明年，我們的重點仍將是償還債務。在我們將其他資本分配給併購之前，我們將償還剩餘的定期貸款。

Our next question comes from David Saxon with Needham & Company.

我們的下一個問題來自 Needham & Company 的 David Saxon。

Maybe to start on extremities. Just wondering what you're seeing in the foot and ankle market. Did any procedures perform better or worse than others? And then I'll ask my second question upfront here. Maybe can you talk about the Q Guidance System, how that early launch is going? And maybe you can touch on the launch strategy, pricing and feedback you got from NASS?

也許從四肢開始。只是想知道你在腳踝市場看到了什麼。是否有任何程序比其他程序執行得更好或更差？然後我會在這裡提前問我的第二個問題。也許你能談談 Q Guidance System，早期發布的進展如何？也許您可以談談您從 NASS 獲得的發布策略、定價和反饋？

Yes. So starting with Foot & Ankle, they had a really terrific Q3. The highest growth within Foot & Ankle is coming out of our total ankle where we have a clear market leadership. That had double-digit growth. But even though the midfoot, forefoot procedures are picking back up, as you know, the pandemic did kind of slowed them the most somewhat, but they had a very good Q3. We had a number of new launches in that category, forefoot launches. So we're feeling very good about that going forward.

是的。因此，從 Foot & Ankle 開始，他們的第三季度表現非常出色。 Foot & Ankle 中最高的增長來自於我們擁有明確市場領導地位的整個腳踝。那有兩位數的增長。但是，儘管中足、前足的程序正在恢復，正如你所知，大流行確實在某種程度上減慢了它們的速度，但它們的第三季度表現非常好。我們在該類別中推出了許多新產品，前腳掌推出。所以我們對未來的發展感覺非常好。

But it was a strong Q3 that contributed to -- especially in the United States, that contributed to the double-digit growth that we had in Trauma Extremities in the U.S. in the second -- oh, Q Guidance, yes, we had really terrific feedback because it's an incredibly fast, internally developed camera. Much faster than what you see the competition using. It also actually provides suggestions about which screws to use. And so that's very novel as well.

但這是一個強勁的第三季度，尤其是在美國，促成了我們第二季度在美國創傷四肢的兩位數增長——哦，Q Guidance，是的，我們真的很棒反饋，因為它是一款速度極快的內部開發相機。比您看到的競爭對手使用的要快得多。它實際上還提供了有關使用哪些螺釘的建議。所以這也很新穎。

And that will be the camera that will be ported to Mako for the future, and it really simplifies the workflow. Very, very positive feedback. That contributed to the strong enabling technology performance. So we had a number of very good sales of the Q Guidance System in Q3, and that's picking up into Q4. So, so far, so good on that launch.

這將是將來移植到 Mako 的相機，它確實簡化了工作流程。非常非常積極的反饋。這促成了強大的使能技術性能。因此，我們在第三季度的 Q Guidance System 銷量非常好，並且在第四季度有所回升。所以，到目前為止，這次發射做得很好。

Obviously, we still want it to get to Mako. And we also have another project called Copilot. That's the kind of an internal code name, which is really around drills and providing some haptic feedback, which we were able to show some of the surgeons at NASS to great feedback because that doesn't exist in the market today.

顯然，我們仍然希望它到達 Mako。我們還有另一個名為 Copilot 的項目。那是一種內部代號，它實際上是圍繞演習並提供一些觸覺反饋，我們能夠向 NASS 的一些外科醫生展示很好的反饋，因為這在今天的市場上並不存在。

So we have a pretty comprehensive portfolio and enabling technology for Spine. It's going to take us some time to bring these additional products to the market, but Q Guidance was very well received, especially because of the speed and efficiency that we offer without requiring them to change their workflow.

因此，我們為 Spine 提供了非常全面的產品組合和支持技術。我們需要一些時間才能將這些附加產品推向市場，但 Q Guidance 非常受歡迎，特別是因為我們提供的速度和效率無需他們改變工作流程。

Our next question comes from Steven Lichtman with Oppenheimer.

我們的下一個問題來自奧本海默的 Steven Lichtman。

A couple of follow-ups. Jason, in capital, we talked a lot this evening about supply. But in the prepared remarks, you talked about installation delays due to variability in the hospital environment and scheduling challenges. Can you provide a little more color on what you're seeing specifically when you talk about that and the variability? And were those comments related to both traditional Medical and Mako? And then I just have a quick one for Glenn.

幾個後續。傑森，在首都，我們今晚談了很多關於供應的問題。但是在準備好的評論中，您談到了由於醫院環境的可變性和調度挑戰導致的安裝延遲。當您談論它和可變性時，您能否提供更多關於您所看到的具體內容的顏色？這些評論是否與傳統醫學和 Mako 有關？然後我就給格倫做了一個快速的。

Yes. I'd say a couple of different things just as you think about that. And think about capital. Obviously, our larger capital is beyond Mako, right? But what we're seeing is sometimes, I think when we talk about staffing challenges, people go right to nurses and some of those things. But really, what we're talking about here is even like if you think about our comm business, you'll have scheduled installations. People show up to do an install. They'll get canceled. They'll have to come back. And so that's the variability that I'm referring to that sometimes delays installs, and ultimately, revenue and gets pushed out. Glenn, in terms of second piece?

是的。正如你所想的那樣，我會說一些不同的事情。想想資本。顯然，我們更大的資本已經超越了 Mako，對吧？但是我們有時看到的是，我認為當我們談論人員配備挑戰時，人們會直接去找護士和其中一些事情。但實際上，我們在這裡談論的甚至就像如果您考慮我們的通信業務，您將有預定的安裝。人們出現進行安裝。他們會被取消。他們必須回來。這就是我所指的可變性，有時會延遲安裝，並最終導致收入和被淘汰。格倫，就第二件而言？

He didn't ask yet.

他還沒問。

Yes. So Glenn, just my -- the follow-up for Glen, just one variable for next year I wanted to ask you about is FX. So I mean based on where rates are today, I mean, you talked about some of the -- qualitatively about the impact next year, but would the impact next year versus this be about the same as what you're seeing this year versus last based on where rates are sitting today?

是的。所以格倫，只是我的——格倫的後續行動，明年我想問你的一個變量是外匯。所以我的意思是根據今天的利率，我的意思是，你談到了一些 - 定性地關於明年的影響，但明年與今年的影響是否與你今年與去年看到的影響大致相同根據今天的利率？

Yes. I think without doing the math or having any other basis in next year, if I just look at rates, it's, yes, roughly going to be the same.

是的。我認為明年不做數學計算或有任何其他基礎，如果我只看利率，是的，大致相同。

We'll be more precise in January, but that's a pretty good starting point.

我們將在一月份更準確，但這是一個很好的起點。

Our next question comes from Ryan Zimmerman with BTIG.

我們的下一個問題來自 BTIG 的 Ryan Zimmerman。

Happy Halloween. Just a couple for me. Kevin, we're a few years past the K2 acquisition. And given where the performance has been these past few years, I wanted to get your assessment of kind of the Spine business and how you feel that's come together. And that dovetails into my next question, which is just Vocera having some disruptions, what did you learn from the disruptions in K2? And kind of what are you expecting from the disruption you have in Vocera and how you maybe improve upon what you went through with K2 in terms of disruptions with Vocera?

萬聖節快樂。對我來說只是一對。凱文，我們已經過去幾年收購 K2。鑑於過去幾年的表現，我想了解您對 Spine 業務的評估以及您對這些業務的看法。這與我的下一個問題相吻合，即 Vocera 出現了一些中斷，你從 K2 的中斷中學到了什麼？您對 Vocera 的中斷有何期待，以及您如何改進您在 K2 中所經歷的 Vocera 中斷？

Yes. So let me first say that the Vocera disruption is very different than K2M disruption. K2M is an overlap deal, where you have the same sales reps selling the same kinds of products. That's the hardest kind of deal to integrate. Frankly, we learned a lot from K2M that we then put into our Wright Medical integration, which has gone extremely well. That's more analogous where the Foot & Ankle as an example, or upper extremities, you have overlapping reps.

是的。因此，我首先要說 Vocera 顛覆與 K2M 顛覆非常不同。 K2M 是一種重疊交易，您有相同的銷售代表銷售相同種類的產品。這是最難整合的交易。坦率地說，我們從 K2M 中學到了很多，然後我們將其投入到我們的 Wright Medical 整合中，並且進展非常順利。這更類似於以腳和腳踝為例，或者上肢，你有重疊的代表。

Vocera is not an overlap deal. So that one is going to be a lot easier to get through. We did the same thing with Physio-Control. If you remember, we merged the emergency care, our powered costs for the ambulances with defibrillators, and we merged that sales force. And we had some disruption in the first year, but we got through it pretty fast. And then we got into a torrid double-digit kind of growth trajectory thereafter.

Vocera 不是重疊交易。因此，通過這一點將容易得多。我們對 Physio-Control 做了同樣的事情。如果你還記得，我們將急救護理、救護車的動力成本與除顫器合併，我們合併了銷售團隊。我們在第一年遇到了一些干擾，但我們很快就度過了難關。然後我們進入了一個狂熱的兩位數增長軌跡。

So Vocera will have a little bit of disruption. It's not just because of the sales force, but also because we'd like to move more of the business to the cloud, which will be better for us and better for our customers long term versus being on-premise. And so we don't mind taking a little bit of pain in the -- for the next quarter or 2. But thereafter, you should expect that to be able to sing. It's a lot easier from an integration standpoint. This is just running the Stryker offense without having to have reps competing.

所以 Vocera 會有一點中斷。這不僅是因為銷售人員，還因為我們希望將更多業務轉移到雲上，這對我們和長期客戶來說都比在內部部署更好。因此，我們不介意在下一季度或第二季度承受一點痛苦。但此後，您應該期望它能夠唱歌。從集成的角度來看，這要容易得多。這只是運行 Stryker 進攻，而不必讓代表競爭。

As I think about spine, it's obviously the most competitive market we play in. It's a very tough market. K2M was not a very expensive acquisition compared to alternatives that we looked at, at the time. It's been an okay deal. It hasn't been one of our best deals, but it solved a problem for us where we would have frankly been growing below-market rates had we not done the deal. We were able to kind of hang on to be able to grow around market rates with some good innovation. And now that we've got our enabling technology road map, I'm actually pretty excited about spine in the future.

當我想到脊椎時，它顯然是我們所從事的最具競爭力的市場。這是一個非常艱難的市場。與我們當時看到的替代方案相比，K2M 並不是一項非常昂貴的收購。這是一筆不錯的交易。這不是我們最好的交易之一，但它為我們解決了一個問題，坦率地說，如果我們沒有完成交易，我們會以低於市場的價格增長。我們能夠堅持下去，通過一些好的創新來圍繞市場價格增長。現在我們已經有了我們的支持技術路線圖，我實際上對未來的脊椎感到非常興奮。

It's going to continue to be a bit of a dogfight through sort of the end of next year, but going into '24, already with Q Guidance, we have a bit of a spring in our step, a new expandable distribution deal with Life Spine. So we're starting to feel a little bit of momentum, our [Monterey] new launch as well.

到明年年底，這將繼續有點混戰，但進入 24 年，已經有了 Q Guidance，我們邁出了一步，與 Life Spine 達成了一項新的可擴展分銷協議.所以我們開始感受到一點動力，我們的 [Monterey] 新品發布也是如此。

So we're starting to feel a bit of momentum, but it -- not having a robot is a problem. We do have this project with Mako that will help solve that problem. And we are committed to spine long term. But clearly, it is the most challenging market of all. But certainly don't -- for me, Vocera will have probably roughly flat sales growth year-over-year for Q4, Q1, and then you should expect Vocera to start to zoom after that.

所以我們開始感受到一點動力，但它——沒有機器人是個問題。我們確實與 Mako 有這個項目，這將有助於解決這個問題。我們致力於長期脊柱。但顯然，這是最具挑戰性的市場。但當然不要——對我來說，Vocera 在第四季度和第一季度的銷售額同比增長可能大致持平，然後你應該期望 Vocera 在那之後開始增長。

That's very helpful. And then if I could just squeeze one more in real quick. In terms of delivery, you talked about some of the capital cycle and the dynamics of the supply chain. And just if you were to order a product today from you guys and upon receipt, it takes maybe 90 days under normal circumstances, just help us understand some of these orders that are pulling through or extending beyond the quarter. I mean I don't know if you guys, Glenn, want to quantify this. But is it 20 days now because of the delays -- 110 days total, I mean? Is it a few months after? Just as we think about kind of the extension of the order book, which still continues to be strong, what does this mean quantitatively in terms of order to delivery?

這很有幫助。然後，如果我能快速再擠一個。在交付方面，您談到了一些資金周期和供應鏈的動態。如果您今天要從你們那裡訂購產品並且收到後，在正常情況下可能需要 90 天，請幫助我們了解其中一些正在拉動或超出季度的訂單。我的意思是我不知道你們，格倫，是否想量化這個。但是因為延誤，現在是 20 天嗎？我的意思是總共 110 天？是幾個月後嗎？就像我們考慮訂單簿的擴展一樣，它仍然很強勁，從訂單到交付的數量上，這意味著什麼？

Ryan, it's Jason. I'll jump in here. And what I would say is, first off, I'd point you back to my prepared remarks in terms of this being a moderate tailwind for some time, right? In terms of how much longer is the delivery cycle, candidly, it's going to vary by product cycle, right, or the type of product that it is. And so we're certainly not going to quantify in terms of the impact there, but it certainly does vary.

瑞恩，是傑森。我會跳到這裡。我要說的是，首先，我會向你指出我準備好的言論，因為這在一段時間內是溫和的順風，對吧？坦率地說，就交付週期有多長而言，它會因產品週期或產品類型而異。所以我們當然不會量化那裡的影響，但它肯定會有所不同。

Our next question comes from Matt Taylor with Jefferies.

我們的下一個問題來自 Jefferies 的 Matt Taylor。

I'll just ask a follow-up on that theme, I guess. I was really interested in your comments about kind of the procedural backlog and perhaps taking some time to burn off in addition to your order book. So the reality of that is just to ask, a, are there areas of your portfolio where you see greater or lesser backlog, just to help us think about how those things could come back over time? And I guess, what are you looking at to predict that you could actually see this procedural runoff take more than 2023 and into 2024?

我想我會問一個關於這個主題的後續行動。我真的很感興趣你對程序積壓的評論，除了你的訂單之外，可能還需要一些時間來燒掉。所以實際情況只是問，a，你的投資組合中是否有更多或更少的積壓，只是為了幫助我們思考這些事情如何隨著時間的推移而恢復？而且我猜，你在看什麼來預測你實際上可以看到這個程序性徑流需要超過 2023 年並進入 2024 年？

Yes. I think hip and knees are the areas where I think it's not just a Stryker thing. I think the market will be more robust. And certainly, you can talk to our competitors, and I think they would share that osteoarthritis doesn't improve itself. These patients are going to need these procedures. Aging population and demographics play in our favor. And I think you're going to see that tailwind.

是的。我認為臀部和膝蓋是我認為這不僅僅是 Stryker 的地方。我認為市場會更加強勁。當然，您可以與我們的競爭對手交談，我認為他們會同意骨關節炎不會自行改善。這些患者將需要這些程序。人口老齡化和人口統計數據對我們有利。我想你會看到順風。

It's just -- I just don't think it's going to be -- surgeons aren't going to be operating on weekends, and their staff's not available to have a big spike and then kind of a return to normal. That's why I think it will be a gradual tailwind for multiple quarters. But those are -- that's the business I think you're going to see that kind of sustained positive momentum on the surgery volumes.

只是——我只是不認為會這樣——外科醫生不會在周末進行手術，他們的工作人員也無法在出現大幅飆升然後恢復正常的情況下進行手術。這就是為什麼我認為這將是多個季度的漸進順風。但那些是 - 我認為你會看到手術量持續的積極勢頭。

The next question comes from Richard Newitter with Truist.

下一個問題來自Truist 的Richard Newitter。

This is Sam on for the team. Just -- I'll just ask both guys upfront. Just on SG&A about, call it, 100-ish basis points improvement in 2Q, 3Q here, should we think about that being sustainable in the 4Q? And then with the restructuring, is there room for that to continue to improve into '23? And then similar question on R&D. I mean, should we think about that 7% level being right for the full year? And how should we think about that directionally into '23?

這是 Sam 的團隊。只是 - 我會提前問兩個人。就 SG&A 而言，稱之為 2Q、3Q 100 個基點的改善，我們是否應該考慮到這在 4Q 是可持續的？然後隨著重組，是否有繼續改進到 23 年的空間？然後是關於研發的類似問題。我的意思是，我們應該認為 7% 的水平適合全年嗎？我們應該如何直接考慮到 23 年？

Yes. Sam, this is Glenn. On SG&A, I think generally, the only thing that really becomes significantly variable is just sales commissions that flows through there. So in terms of the kind of procedures and controls that we put in place relative to discretionary cost control, we should see that continue into Q4. And so that's probably a pretty good proxy.

是的。山姆，這是格倫。在 SG&A 上，我認為一般來說，唯一真正變得顯著變化的是流經那裡的銷售佣金。因此，就我們實施的與可自由支配成本控制相關的程序和控製而言，我們應該會看到這種情況持續到第四季度。所以這可能是一個很好的代理。

And then on R&D, we've been hovering at that level, honestly, for several quarters. And so the only variability might be that sales are a little larger in Q4, which might actually make the percentage go down a little bit in R&D. But I do think that, that run rate is a good approximate.

然後在研發方面，老實說，我們已經在這個水平上徘徊了幾個季度。因此，唯一的變化可能是第四季度的銷售額略大，這實際上可能使研發的百分比略有下降。但我確實認為，運行速度是一個很好的近似值。

For the full year.

全年。

For the full year.

全年。

Is that on a dollar basis?

是按美元計算的嗎？

On a percentage basis.

按百分比計算。

Percentage.

百分比。

6%, 7% of sales roughly, that's a pretty good number for a full year. Keep in mind, Q4 is seasonally our strongest. So you are going to see much higher op margin than you've seen certainly in the last 2 quarters in Q4.

6%，大約是銷售額的 7%，對於一整年來說，這是一個相當不錯的數字。請記住，第四季度是我們季節性最強的。因此，您將看到比第四季度最後兩個季度肯定看到的更高的運營利潤率。

Our next question comes from Jayson Bedford with Raymond James.

我們的下一個問題來自 Jayson Bedford 和 Raymond James。

I'll just be quick here, realizing we're deep into the call. But just on China, when do you expect the VBP dynamics to subside or anniversary for you?

我會很快在這裡，意識到我們已經深入到電話中了。但就中國而言，您預計 VBP 的動態何時會消退或紀念您？

This is Jason. I'll take this one. So just as a reminder, right, China overall is less than 2% of our sales. And the sales that are exposed to VBP are actually less than 1%, so fairly immaterial. But relative to kind of the next impact, there will be an impact as we go into next year around NV. Obviously, we're not going to guide at this point, but you'll hear more about that as we get into next year.

這是傑森。我要這個。所以提醒一下，對，中國整體銷售額不到我們銷售額的 2%。而接觸 VBP 的銷售額實際上不到 1%，因此相當無關緊要。但相對於下一次影響，我們將在明年 NV 附近產生影響。顯然，我們現在不打算提供指導，但是當我們進入明年時，你會聽到更多關於這方面的信息。

And Jason, does that start in '23? Or will you see any impact here in the fourth quarter?

傑森，那是從 23 年開始的嗎？或者您會在第四季度看到任何影響嗎？

It will start in '23. Again, we'll talk more about timing when we get closer, but it will be '23.

它將在 23 年開始。再一次，我們將更多地談論我們接近時的時間，但這將是 23 年。

Our next question comes from Jeff Johnson with Baird.

我們的下一個問題來自 Jeff Johnson 和 Baird。

Just a quick follow-up. Really, just a clarification. Jason, in your prepared remarks, you talked about Mako installs being delayed during the quarter. I think in a follow-up to Larry Biegelsen's question, you talked about orders for Mako being soft. Just was it orders? Was it the installs? And maybe a little more color just on what exactly happened in the third quarter and what the confidence is on it recovering in the fourth?

只是快速跟進。真的，只是一個澄清。 Jason，在您準備好的評論中，您談到了 Mako 安裝在本季度被延遲。我認為在拉里·比格爾森的問題的後續行動中，你談到了對 Mako 的命令是軟的。只是命令嗎？是安裝嗎？也許對第三季度到底發生了什麼以及第四季度恢復的信心有更多的了解？

Yes. No, my comments were definitely specific to installs. I may have made a comment relative to a strong order book, which is absolutely the case, and we do expect a strong fourth quarter.

是的。不，我的評論絕對是針對安裝的。我可能對強勁的訂單發表了評論，這絕對是這樣，我們確實預計第四季度會表現強勁。

There are no more questions waiting. So I will pass the conference back over to Kevin Lobo for closing remarks.

沒有更多的問題在等待。因此，我將把會議交回給 Kevin Lobo 做閉幕詞。

Well, thank you all for joining our call. We look forward to sharing our fourth quarter and full year-end 2022 results with you as well as our 2023 guidance in January. Thank you.

嗯，謝謝大家加入我們的電話。我們期待與您分享 2022 年第四季度和全年的業績，以及 1 月份的 2023 年指導。謝謝你。

That concludes today's call. Thank you for your participation. You may now disconnect your lines.

今天的電話會議到此結束。感謝您的參與。您現在可以斷開線路。