史賽克 (SYK) 2023 Q4 法說會逐字稿

Welcome to the Fourth Quarter and Full Year 2023 Stryker Earnings Call. My name is Luke, and I'll be your operator for today's call. (Operator Instructions) This conference call is being recorded for replay purposes.

歡迎參加 Stryker 2023 年第四季和全年財報電話會議。我叫盧克，我是今天電話的接線生。 （操作員說明）本次電話會議正在錄音以供重播。

Before we begin, I'd like to remind you that 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 comparable GAAP financial measures can be found in today's press release that is an exhibit to Stryker's current report on Form 8-K filed today with the SEC. I would now like to turn the call over to Mr. Kevin Lobo, Chair and Chief Executive Officer. You may proceed, sir.

在我們開始之前，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，討論還將包括某些非公認會計準則財務措施。在今天的新聞稿中可以找到與最直接可比較的 GAAP 財務指標的調節表，該新聞稿是 Stryker 今天向 SEC 提交的 8-K 表格當前報告的展示。我現在想將電話轉給董事長兼執行長 Kevin Lobo 先生。您可以繼續了，先生。

Welcome to Stryker's fourth quarter earnings call. Joining me today are Glenn Boehnlein, Stryker's CFO; and Jason Beach, Vice President of Investor Relations. For today's call, I'll provide opening comments, followed by Jason with the trends we saw during the quarter, Mako performance insights, and updates on recent acquisitions. Glenn will then provide additional details regarding our quarterly results and 2024 guidance before opening the call to Q&A.

歡迎參加 Stryker 第四季財報電話會議。今天加入我的是 Stryker 財務長 Glenn Boehnlein；和投資者關係副總裁 Jason Beach。在今天的電話會議中，我將發表開場評論，隨後 Jason 介紹我們在本季度看到的趨勢、Mako 業績見解以及最近收購的最新情況。然後，格倫將在開始問答電話之前提供有關我們的季度業績和 2024 年指導的更多詳細資訊。

First, I want to recognize and celebrate our achievement of surpassing $20 billion in sales. We continue to be a high-growth company with a focus on our mission to deliver for our patients and customers. As we begin 2024, I am very excited about our future. We are in a strong position with robust demand across both procedures and capital, easing macro constraints and a strong pipeline of innovation. I want to thank our over 50,000 employees for their unrelenting determination, agility and performance.

首先，我想表彰並慶祝我們銷售額超過 200 億美元的成就。我們將繼續成為一家高成長的公司，專注於為患者和客戶提供服務的使命。 2024 年伊始，我對我們的未來感到非常興奮。我們處於有利地位，在程序和資本方面都有強勁的需求，緩解了宏觀限制，並擁有強大的創新管道。我要感謝我們 50,000 多名員工堅持不懈的決心、敏捷性和表現。

We've delivered terrific sales growth of over 11% in Q4 and the full year despite strong comparatives from the prior year. Our commercial execution, including many successful product introductions, was excellent across our businesses and regions. Globally, for both Q4 and the full year, we had double-digit organic sales growth in Instruments, Endoscopy, Medical, Neuro Cranial, Hips, Knees and Trauma and Extremities. For the full year, we also had double-digit organic sales growth both in the U.S. and internationally. Spine and Neurovascular also demonstrated good performances while making notable advancements in future innovations and acquisitions. It was a comprehensive performance across our businesses, and we have built significant momentum entering 2024.

儘管與上年相比強勁，但我們第四季和全年的銷售額成長超過 11%。我們的商業執行（包括許多成功的產品推出）在我們的業務和地區都非常出色。在全球範圍內，第四季度和全年，我們在儀器、內視鏡、醫療、神經顱腦、臀部、膝蓋以及創傷和四肢領域實現了兩位數的有機銷售增長。全年，我們在美國和國際市場的有機銷售額也實現了兩位數的成長。脊椎和神經血管也表現出了良好的表現，同時在未來的創新和收購方面取得了顯著的進展。這是我們各個業務的綜合表現，我們已經在進入 2024 年建立了強勁的勢頭。

For the sixth straight year, our international sales growth, excluding China VBP, outpaced our strong U.S. business. Canada, Australia and most emerging markets had double-digit growth, while Europe and Japan grew in high single digits. International continues to be a large growth opportunity for us.

連續第六年，我們的國際銷售成長（不包括中國 VBP）超過了我們強勁的美國業務。加拿大、澳洲和大多數新興市場實現了兩位數成長，而歐洲和日本則實現了高個位數成長。國際業務對我們來說仍然是一個巨大的成長機會。

Next, we delivered quarterly and full year adjusted EPS of $3.46 and $10.60, respectively, which represents 15% growth for Q4 and 13% growth compared to the full year of 2022. This was driven by our strong sales but also demonstrates our continued operating margin recovery. We remain focused on driving high growth now and in the future through investments in organic innovation and M&A. We expect to continue to deliver sales growth at the high end of med tech, which is reflected in our full year 2024 guidance of organic sales growth of 7.5% to 9%. This growth, combined with an accelerated margin expansion plan, translates to adjusted EPS of $11.70 to $12 per share. I will now turn the call over to Jason.

接下來，我們的季度和全年調整後每股收益分別為3.46 美元和10.60 美元，與2022 年相比，第四季度增長15%，全年增長13%。這是由我們強勁的銷售推動的，但也顯示我們持續的營業利潤率恢復。我們仍然專注於透過有機創新和併購投資來推動現在和未來的高成長。我們預計醫療技術高端領域的銷售將繼續成長，這反映在我們 2024 年全年有機銷售成長 7.5% 至 9% 的指導中。這一增長加上加速的利潤擴張計劃，調整後每股收益為 11.70 美元至 12 美元。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 as well as Mako, Vocera and our recently announced agreement to acquire SERF. During the quarter, we saw strong procedural demand. We continue to expect the ortho markets will remain strong in 2024, driven by continued adoption in robotic-assisted surgery, demographics, a more favorable pricing environment, and healthy patient activity levels with surgeons. While supply constraints continue in pockets around the globe, our supply is stable overall and gradually improving.

謝謝，凱文。我今天的評論將重點介紹當前環境以及 Mako、Vocera 和我們最近宣布的收購 SERF 協議的最新情況。在本季度，我們看到了強勁的程序需求。我們仍然預計，在機器人輔助手術的持續採用、人口統計、更有利的定價環境以及外科醫生健康的患者活動水平的推動下，骨科市場將在 2024 年保持強勁。儘管全球部分地區的供應仍然受到限制，但我們的供應總體穩定並逐步改善。

Additionally, demand for our capital products remained very robust in the quarter, with double-digit organic growth in Medical, Instruments and Endoscopy. Hospital CapEx budgets remain healthy, and our capital order book remains elevated as we enter 2024.

此外，本季對我們資本產品的需求仍然非常強勁，醫療、儀器和內視鏡領域實現了兩位數的有機成長。進入 2024 年，醫院資本支出預算保持健康，我們的資本訂單簿仍保持在高水準。

Next, specific to Mako, we had a record quarter of installations globally. The progress of our Mako offense, including our recent direct-to-consumer campaign, has resulted in strong growth of our installed base alongside continued increases in utilization. In the U.S., we saw 60% of Knees and 34% of Hips performed using Mako as we exited the year. Globally, we exited the year with just over 40% of Knees and nearing 20% of Hips performed using Mako. We have momentum, and a significant opportunity remains as Mako adoption increases.

接下來，具體到 Mako，我們在全球範圍內的安裝量創下了季度記錄。我們的 Mako 攻勢的進展，包括我們最近的直接面向消費者的活動，導致我們的安裝基礎強勁增長，同時利用率持續提高。在美國，我們看到 60% 的膝蓋和 34% 的臀部在年底時使用 Mako 進行訓練。在全球範圍內，今年結束時，我們有超過 40% 的膝蓋和近 20% 的臀部使用 Mako 進行訓練。我們有動力，隨著 Mako 採用率的增加，仍然存在重大機會。

We are nearing the 2-year anniversary of our Vocera acquisition and remain very excited about the acquired assets, as it provides a platform for us to be at the intersection of medical devices, software and clinical support. With integration activities now complete, which included a migration towards the cloud as well as the commercial reorganization, we are pleased with the accelerating double-digit sales and order growth achieved as we exited the year. In 2023, we saw many cross-sell wins, including new bed business leveraging Vocera.

我們即將迎來收購 Vocera 的兩週年紀念日，並且對所收購的資產仍然感到非常興奮，因為它為我們提供了一個融合醫療設備、軟體和臨床支援的平台。隨著整合活動（包括向雲端遷移以及商業重組）的完成，我們對今年結束時實現的兩位數銷售和訂單成長加速感到高興。 2023 年，我們看到了許多交叉銷售的勝利，包括利用 Vocera 的新床業務。

Also, we completed the seamless experience created between the Vocera platform and both ProCuity and our new wireless structure. This year and beyond will bring even more integrations and enhancements with a focus on scalability, user experience, automated workflow and documentation. We expect strong double-digit annual sales growth to continue for years to come, and we are excited to have Vocera as part of the Stryker family.

此外，我們還完成了 Vocera 平台與 ProCuity 以及我們新的無線結構之間創建的無縫體驗。今年及以後，我們將帶來更多整合和增強功能，重點關注可擴展性、使用者體驗、自動化工作流程和文件。我們預計未來幾年年銷售額將持續強勁的兩位數成長，我們很高興 Vocera 成為 Stryker 大家庭的一員。

Lastly, we are progressing with our recently announced agreement to acquire SERF, and we expect the deal will close this quarter. With that, I will now turn the call over to Glenn.

最後，我們正在推動最近宣布的收購 SERF 的協議，我們預計該交易將於本季完成。現在，我將把電話轉給格倫。

Thanks, Jason. Today, I will focus my comments on our fourth quarter financial results and the related drivers. Our detailed financial results have been provided in today's press release. Our organic sales growth was 11.4% in the quarter, compared to 13.2% organic growth in the fourth quarter of 2022. The fourth quarter of 2023 has the same number of selling days as 2022. The impact from pricing in the quarter was favorable by 0.7%. We continue to see a positive trend from our pricing initiatives, particularly in our MedSurg and Neurotech businesses, all of which contributed positive pricing for the quarter.

謝謝，傑森。今天，我將重點放在我們第四季的財務表現和相關驅動因素。我們詳細的財務業績已在今天的新聞稿中提供。我們本季的有機銷售成長為 11.4%，而 2022 年第四季的有機成長為 13.2%。2023 年第四季的銷售天數與 2022 年相同。該季度定價的影響有利 0.7 %。我們的定價舉措繼續呈現積極趨勢，特別是在我們的 MedSurg 和 Neurotech 業務中，所有這些業務為本季度帶來了積極的定價。

Foreign currency had a 0.3% favorable impact on sales in the quarter. In the quarter, U.S. organic sales growth was 12.7%. International organic sales growth was 7.7%, against a very strong comparable of over 18% in 2022. This performance included positive sales momentum across most of our international markets, particularly Australia, Canada, Japan and most emerging markets. For the year, organic sales growth was 11.5%, with U.S. organic sales growth of 11.7% and international organic sales growth of 10.9%. Excluding the impact of China VBP, international growth was 12.8%.

外幣對該季度的銷售額產生了 0.3% 的有利影響。本季度，美國有機銷售額成長 12.7%。國際有機銷售額成長率為 7.7%，而 2022 年的可比成長率超過 18%。這一業績包括我們大多數國際市場的積極銷售勢頭，特別是澳洲、加拿大、日本和大多數新興市場。全年有機銷售額成長 11.5%，其中美國有機銷售額成長 11.7%，國際有機銷售額成長 10.9%。剔除中國VBP的影響，國際成長率為12.8%。

The impact for pricing in the year was favorable 0.6%. Foreign currency had a 0.5% unfavorable impact, and 2023 has the same number of selling days as 2022. Our adjusted EPS of $3.46 in the quarter was up 15.3% from 2022, driven by higher sales and operating margin expansion as well as lower other income and expenses. Foreign currency exchange translation had a favorable impact of $0.02. Our full year adjusted EPS was $10.60, which represents growth of 13.5% from full year 2022, reflecting the favorable impact of sales growth and operating margin expansion, partially offset by the unfavorable impact of foreign currency exchange translation of $0.10.

今年對定價的影響有利 0.6%。外幣帶來了0.5% 的不利影響，2023 年的銷售天數與2022 年相同。本季調整後每股收益為3.46 美元，較2022 年增長15.3%，這主要得益於銷售和營業利潤率擴張以及其他收入下降和費用。外幣兌換折算產生了 0.02 美元的有利影響。我們全年調整後每股收益為 10.60 美元，較 2022 年全年增長 13.5%，反映出銷售成長和營業利潤率擴張的有利影響，部分被外幣兌換帶來的 0.10 美元不利影響所抵消。

Now I will provide some highlights around our quarterly segment performance. In the quarter, MedSurg and Neurotechnology had constant currency sales growth of 12% and organic sales growth of 11.8%, which included 13.8% of U.S. organic growth and 5.7% of international growth. Instruments had U.S. organic sales growth of 11.5%, with strong double-digit growth across its Surgical Technologies and Orthopaedic Instruments businesses. From a product perspective, sales growth was led by power tools, Steri-Shield, smoke evacuation and SurgiCount. Endoscopy had U.S. organic sales growth of 17.9%, with double-digit growth in its communications, endo BU and Sports Medicine businesses. From a product perspective, this includes strong growth in booms, lights and video. During the quarter, the Endoscopy business continued to see very strong momentum of the 1788 camera system, which had its full launch in September.

現在我將提供有關我們季度業績的一些亮點。本季度，MedSurg 和 Neurotechnology 的固定貨幣銷售額成長 12%，有機銷售額成長 11.8%，其中美國有機成長 13.8%，國際成長 5.7%。 Instruments 在美國的有機銷售額成長了 11.5%，其中外科技術和骨科器械業務實現了兩位數的強勁成長。從產品角度來看，電動工具、Steri-Shield、排煙和 SurgiCount 引領了銷售成長。內視鏡業務在美國的有機銷售額成長了 17.9%，其中通訊、內視鏡業務部門和運動醫學業務實現了兩位數成長。從產品角度來看，這包括吊桿、燈光和視訊的強勁成長。本季度，內視鏡業務繼續看到 1788 攝影系統的強勁勢頭，該系統於 9 月全面推出。

Medical had U.S. organic sales growth of 12.9%, led by performances in its Vocera, Acute Care and Sage businesses. This included strong growth in Vocera badges, beds, structures and Prevalon repositioning products. All of this was against a very strong comparable growth of over 20% in 2022. Neurovascular had U.S. organic sales growth of 7.6%, reflecting solid performance in our hemorrhagic business. Neuro Cranial had U.S. organic sales growth of 14%, which included double-digit growth in the Neurosurgical and ENT businesses, with strong growth in high-speed drill and balloon dilation products.

在 Vocera、Acute Care 和 Sage 業務表現的帶動下，醫療器材在美國的有機銷售額成長了 12.9%。其中包括 Vocera 徽章、床、結構和 Prevalon 重新定位產品的強勁成長。所有這些都與 2022 年超過 20% 的強勁可比增長形成鮮明對比。神經血管業務在美國的有機銷售額增長了 7.6%，反映出我們血液業務的穩健表現。 Neuro Cranial 在美國的有機銷售額成長了 14%，其中神經外科和耳鼻喉科業務實現了兩位數成長，高速鑽和球囊擴張產品成長強勁。

Internationally, MedSurg and Neurotechnology had organic sales growth of 5.7%, reflecting double-digit growth in our Instruments and Neuro Cranial businesses. Geographically, this included strong performances in Australia, Canada and Japan.

在國際上，MedSurg 和 Neurotechnology 的有機銷售額成長了 5.7%，反映了我們的儀器和神經顱腦業務的兩位數成長。從地域上看，澳洲、加拿大和日本表現強勁。

Orthopaedics and Spine had constant currency and organic sales growth of 10.7%, which included organic growth of 10.9% in the U.S. and 10.1% internationally. Our U.S. knee business grew 12.9% organically, which reflects our market-leading position in robotic-assisted knee procedures. Our U.S. hip business also grew 12.9% organically, reflecting solid primary hip growth fueled by our Insignia Hip Stem.

骨科和脊椎業務的固定匯率和有機銷售額成長 10.7%，其中美國有機成長 10.9%，國際有機成長 10.1%。我們的美國膝關節業務有機成長 12.9%，這反映了我們在機器人輔助膝關節手術的市場領先地位。我們的美國髖關節業務也實現了 12.9% 的有機成長，反映出我們的 Insignia 髖關節柄推動了初級髖關節的穩健成長。

Our U.S. Trauma and Extremities business grew 12.1% organically with strong performances across all of its businesses, including upper extremities, biologics, core trauma, and foot and ankle. Our U.S. spine business grew 6%, led by the performance in our enabling technology and Interventional Spine businesses. Internationally, Orthopaedics and Spine grew 10.1% organically, including strong performances in Canada and most emerging markets, particularly driven by Mako and strong knee performance across most geographies.

我們的美國創傷和四肢業務有機成長 12.1%，所有業務均表現強勁，包括上肢、生物製劑、核心創傷以及足部和踝關節。我們的美國脊椎業務成長了 6%，這主要得益於我們的支援技術和介入脊椎業務的表現。在國際上，骨科和脊椎業務有機成長 10.1%，其中加拿大和大多數新興市場表現強勁，尤其是受到 Mako 和大多數地區膝蓋表現強勁的推動。

Now I will focus on operating highlights in the fourth quarter. Our adjusted gross margin of 63.9% was favorably -- was favorable approximately 120 basis points from the fourth quarter of 2022. This improvement was primarily driven by the continued easing of certain cost pressures, including the elimination of spot buy purchases that we experienced in 2022 and the continued benefit of pricing initiatives. Adjusted R&D spending was 5.6% of sales, which was 10 basis points higher than the fourth quarter of 2022. Our adjusted SG&A was 31% of sales, which was 40 basis points higher than the fourth quarter of 2022 due to continued investments, including sales growth incentives and a more normalized cadence of travel and meetings.

下面我將重點介紹一下第四季的經營亮點。我們的調整後毛利率為 63.9%，較 2022 年第四季提高約 120 個基點。這項改善主要是由於某些成本壓力的持續緩解，包括取消我們在 2022 年經歷的現貨採購以及定價措施的持續好處。調整後的研發支出佔銷售額的5.6%，比2022 年第四季高出10 個基點。由於持續投資（包括銷售），我們調整後的SG&A 佔銷售額的31%，比2022 年第四季高40 個基點成長激勵措施以及更規範的旅行和會議節奏。

In summary, for the fourth quarter, our adjusted operating margin was 27.2% of sales, which was approximately 60 basis points favorable to the fourth quarter of 2022. For the full year, our adjusted operating margin was 24.2% of sales, a 40 basis point increase over 2022. This performance is mainly driven by the easing of certain gross margin cost pressures throughout the second half of the year as well as the positive impact of our pricing actions.

綜上所述，第四季度，我們調整後的營業利潤率為銷售額的27.2%，比2022 年第四季有利約60 個基點。全年，我們調整後的營業利潤率為銷售額的24.2 %，比2022 年第四季有利40 個基點。較2022年增加了一個百分點。這一業績主要是由於下半年某些毛利率成本壓力的緩解以及我們的定價行動的積極影響所致。

Adjusted other income and expense of $31 million for the quarter was $23 million lower than 2022, mainly driven by higher interest income and other favorable discrete items. For 2024, we expect our full year other income and expense to be approximately $250 million. Our fourth quarter and full year had an adjusted effective tax rate of 14.6% and 14.1%, respectively, reflecting the impact of geographic mix and certain discrete tax items. For 2024, we expect our full year effective tax rate to be in the range of 14% to 15%.

該季度調整後的其他收入和支出為 3,100 萬美元，比 2022 年減少 2,300 萬美元，主要是由於利息收入增加和其他有利的離散項目所致。 2024 年，我們預計全年其他收入和支出約為 2.5 億美元。我們第四季和全年的調整後有效稅率分別為 14.6% 和 14.1%，反映了地理組合和某些離散稅項的影響。 2024 年，我們預計全年有效稅率將在 14% 至 15% 之間。

Focusing on the balance sheet. We ended the year with $3 billion of cash and marketable securities and total debt of $13 billion. During the year, we paid down the remaining $850 million outstanding on the $1.5 billion term loan associated with the Vocera acquisition and achieved our de-leveraging commitments. In Q4, we also refinanced certain debt maturities, including prefunding of $600 million that is due in May 2024.

重點關注資產負債表。年底，我們擁有 30 億美元的現金和有價證券，總債務為 130 億美元。年內，我們償還了與收購 Vocera 相關的 15 億美元定期貸款中剩餘的 8.5 億美元未償債務，並實現了去槓桿化承諾。在第四季度，我們也為某些到期債務進行了再融資，包括 2024 年 5 月到期的 6 億美元預融資。

Turning to cash flow. Our year-to-date cash from operations was $3.7 billion. This performance reflects the results of net earnings and higher accounts receivable collections. For 2024, we anticipate that capital spending will be $650 million to $700 million. We do not anticipate any share buybacks.

轉向現金流。年初至今，我們的營運現金為 37 億美元。這一業績反映了淨利潤和應收帳款催收增加的結果。 2024 年，我們預計資本支出將為 6.5 億至 7 億美元。我們預計不會進行任何股票回購。

And now I will provide 2024 full year sales and earnings guidance. Based on our momentum from 2023, strong procedural volumes, healthy demand for capital products and a stabilizing macro and economic environment, we expect organic sales growth to be in the range of 7.5% to 9% for 2024. There is 1 additional selling day in 2024 compared to 2023, with 1 less day in Q1 and 1 more day in both Q3 and Q4. Based on the steady progress of our pricing actions, we would expect the full year impact of price to be roughly flat.

現在我將提供 2024 年全年銷售和獲利指引。基於我們2023 年的勢頭、強勁的程序交易量、對資本產品的健康需求以及穩定的宏觀和經濟環境，我們預計2024 年有機銷售增長將在7.5% 至9% 範圍內。預計2024 年將增加 1個銷售日2024 年與 2023 年相比，第一季減少 1 天，第三季和第四季均增加 1 天。基於我們定價行動的穩定進展，我們預計全年價格影響將大致持平。

If foreign exchange rates hold near current levels, we anticipate sales will be modestly unfavorably impacted for the full year, being more negative in the first half of the year. EPS will be negatively impacted $0.05 to $0.10. This is included in our guidance.

如果匯率維持在目前水準附近，我們預計全年銷售將受到輕微不利影響，上半年的負面影響更大。 EPS 將受到 0.05 美元至 0.10 美元的負面影響。這已包含在我們的指南中。

Finally, for the full year 2024, we expect adjusted net earnings per diluted share to be in the range of $11.70 to $12, representing our commitment to accelerated operating margin expansion in 2024 as well as the stabilizing operating environment. While we do not provide quarterly guidance, we do expect seasonality for sales and related earnings to be similar to 2023, but adjusted for the quarterly differences in 2024 selling days. And now I will open up the call for Q&A.

最後，對於 2024 年全年，我們預計調整後每股攤薄淨利潤將在 11.70 美元至 12 美元之間，這體現了我們對 2024 年營業利潤率加速擴張以及穩定經營環境的承諾。雖然我們不提供季度指引，但我們預期銷售和相關收益的季節性將與 2023 年類似，但會根據 2024 年銷售日的季度差異進行調整。現在我將開啟問答環節。

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

（操作員說明）我們的第一個問題來自摩根大通的 Robbie Marcus。

Congrats on another fantastic quarter. Kevin, maybe to start, I feel like it's a bit of deja vu where we were sitting here at exactly this time last year and investors were starting to worry after a good year in 2022 and how good can 2023 be. And now people are wondering about '24. So I was hoping you could give a little color behind the 7.5% to 9% organic sales growth. How much of that is transitory? How much of that is durable pricing? And any key drivers you could point us to?

恭喜又一個精彩的季度。 Kevin，也許首先，我覺得去年的這個時候我們坐在這裡有點似曾相識，投資者在經歷了 2022 年的美好一年後開始擔心 2023 年會有多好。現在人們想知道「24」。因此，我希望您能為 7.5% 至 9% 的有機銷售成長背後提供一些資訊。其中有多少是暫時的？其中有多少是持久定價？您可以向我們指出任何關鍵驅動因素嗎？

It certainly was a terrific year in 2023. We had 9.7% organic the year before and over 11% organic in '23. And frankly, we feel very good going into '24. At some point, you think the comps will start to catch up too a little bit, and so we think 7.5% to 9% is a strong guide. I can tell you, coming off all of the domestic sales meetings, there is tremendous energy and excitement among our teams.

2023 年無疑是了不起的一年。前一年我們的有機比例為 9.7%，23 年的有機比例超過 11%。坦白說，進入 24 年我們感覺非常好。在某些時候，你認為比較會開始追趕太多，所以我們認為 7.5% 到 9% 是一個強而有力的指導。我可以告訴你，在所有的國內銷售會議結束後，我們的團隊都充滿了巨大的活力和興奮。

Procedure volumes are strong. The capital markets are very strong. Hospitals are spending. We have exited the year with more backlog than we began the year, which means, obviously, our orders are continuing to be strong for capital equipment. So we have a number of new launches, again, planned in 2024. Obviously, 2023 was a great year of capitalizing on product launches, whether it's System 9, whether it was Neptune S, whether it was the 1788. We have other launches coming again, so our pipeline of innovation is very strong. And so I expect us to continue to grow at the high end of med tech in a med tech market that is quite healthy.

手術量很大。資本市場非常強勁。醫院都在花錢。今年結束時，我們的積壓訂單比年初還要多，這顯然意味著我們的資本設備訂單持續強勁。因此，我們再次計劃在 2024 年推出許多新產品。顯然，2023 年是充分利用產品發布的一年，無論是 System 9、Neptune S 還是 1788。我們還將推出其他產品同樣，我們的創新管道非常強大。因此，我預計我們將在相當健康的醫療技術市場中繼續在高端醫療技術領域實現成長。

Great. Maybe, Glenn, a follow-up for you. And I appreciate you don't guide quarterly, but there's a lot you could do to help us get models in the right spot based on what you can say. And I guess really, the question is my math is implying 50 to 100 basis points of operating margin expansion. You talked about the top line should look like 2023. And I imagine that looks like a normal comparable quarter in first quarter and maybe some sharper seasonality, then historically down 3Q, up 4Q. Also, anything down the P&L operating margin that we should be considering in that seasonality?

偉大的。格倫，也許是你的後續行動。我很感激你不按季度提供指導，但你可以做很多事情來幫助我們根據你所說的將模型放在正確的位置。我猜真的，問題是我的數學意味著營業利潤率擴張 50 到 100 個基點。您談到頂線應該看起來像 2023 年。我想這看起來像是第一季的正常可比季度，也許有一些更尖銳的季節性，然後歷史上第三季度下降，第四季度上升。此外，在該季節性因素中，我們應該考慮損益營業利潤率下降的因素嗎？

I think, Robbie -- and I tried to sort of lay this out at the end of my guidance there. But I think a good place to start would be to look at sort of the cadence of sales and earnings in 2023 and really just adjust out for 1 selling day in Q1 and then adding 2 on the back end. And so as you look at, hey, Stryker, how are you going to deliver op margin expansion throughout the year? It's probably a little more back half-loaded just based on the cadence that we'll see through the year for sales and related op income.

我想，羅比——我試著在指導的最後闡述這一點。但我認為，一個好的起點是觀察 2023 年銷售和收益的節奏，實際上只是在第一季調整 1 個銷售日，然後在後端添加 2 個銷售日。因此，當您看到，嘿，Stryker，您將如何實現全年營運利潤率的擴張？根據我們將在全年看到的銷售和相關營運收入的節奏，它可能會稍微落後一點。

Our next question will come from Lawrence Biegelsen with Wells Fargo.

我們的下一個問題將來自富國銀行的勞倫斯·比格爾森。

I'll echo Robbie's congratulations on a really strong year and finish to the year. Kevin, I'd love to hear your updated thoughts on M&A headed into 2024. Your focus has been on paying down debt in 2023. Is your focus in '24 on smaller deals? Are you open to considering something larger? And are the target areas the same as the ones you shared at the orthopaedic meeting last year? And I have one follow-up.

我將回應羅比的祝賀，祝賀我度過了非常強勁的一年，並為這一年畫下句號。 Kevin，我很想聽聽您對 2024 年併購的最新想法。您的重點是在 2023 年償還債務。您在 24 年的重點是規模較小的交易嗎？您願意考慮更大的事情嗎？目標領域和去年骨科會議分享的目標領域一樣嗎？我還有一個後續行動。

I would say that we're back on M&A offense now, what I'll call our normal M&A offense. And as you've seen in the past with Stryker, that would typically mean larger volume of tuck-in deals. And those can be large, and they can also be small. But during the pause, while we paid down debt, all of our BD teams worked very actively. Believe me, they have a long list of targets. And we are going to be active now that we've gotten our leverage back to where we'd like to be. So let's say we're back to the normal Stryker offense. Expect us to be doing deals. We are open to larger deals. But our history would tell you that the vast majority of our deals are going to be the smaller tuck-ins, but we can do many deals versus being very limited last year.

我想說，我們現在又回到了併購進攻，我稱之為正常的併購進攻。正如您過去在史賽克 (Stryker) 中看到的那樣，這通常意味著更大數量的內含交易。這些可以很大，也可以很小。但在暫停期間，當我們償還債務時，我們所有的 BD 團隊都非常積極地工作。相信我，他們有一長串目標。既然我們已經把影響力恢復到了我們想要的水平，我們就會積極行動。假設我們回到了正常的史賽克進攻。期待我們進行交易。我們對更大的交易持開放態度。但我們的歷史告訴你，我們的絕大多數交易都將是較小的交易，但我們可以做很多交易，而去年的交易非常有限。

Glenn, to follow up on Robbie's question on the margins. First, is it coming -- the margin expansion coming, how much is coming from gross margin versus operating margin? And are you committed still to the 200 basis points, getting back to the pre-COVID margin by 2025? I mean, it actually -- I don't know if the math -- not to get too much into it, but it looks like -- I thought it looked like over 100 basis points implied in the guidance this year. So I assume we can all figure that out off-line, but just any color on gross versus operating margin and the 200 basis points for the 2-year sprinting back to pre-COVID margins would be helpful.

格倫，在邊緣跟進羅比的問題。首先，利潤率擴張是否即將到來，毛利率與營業利益率的比例是多少？您是否仍致力於 200 個基點，到 2025 年恢復到新冠疫情之前的水平？我的意思是，實際上——我不知道數學是否正確——不要過多考慮，但看起來——我認為今年的指導方針中暗示了超過 100 個基點。因此，我認為我們都可以離線計算出這一點，但毛利率與營業利潤率的任何顏色以及兩年內衝刺回到新冠疫情前的利潤率的 200 個基點都會有所幫助。

Larry, I think, first of all, we're not backing off of our sprint to 2019 op margin at all. And we have clearly a plan to get there by the end of 2025. As I said in the Analyst Day, we have good opportunities in operating expenses and in gross margin. I think if you look at our delivery in 2023, we got about 80 basis points out of gross margin. And we invested in some operating expenses that we had indicated would get back to sort of normalized spend.

拉里，我認為，首先，我們根本不會放棄 2019 年營運利潤率的衝刺。我們明確計劃在 2025 年底之前實現這一目標。正如我在分析師日所說，我們在營運費用和毛利率方面擁有良好的機會。我認為，如果你看看我們 2023 年的交付情況，我們的毛利率大約提高了 80 個基點。我們投資了一些營運費用，我們曾表示這些費用將恢復到正常化支出。

So my thoughts on 2024 is that expansion will generally be led by operating expenses, but there continues to be really good opportunities in gross margins that we continue to work on. And if you think about some of these things, price isn't going away from us. We're still going to continue to work on that. Viju elaborated on the benefit we have of low-cost manufacturing sites, and we'll continue to see expansion there. We have opportunities in purchasing and procurement, supplier consolidation.

因此，我對 2024 年的看法是，擴張通常將由營運費用主導，但我們將繼續努力，在毛利率方面仍然存在非常好的機會。如果您考慮其中一些事情，您會發現價格並沒有遠離我們。我們仍將繼續為此努力。 Viju 詳細闡述了我們低成本製造基地的優勢，我們將繼續看到那裡的擴張。我們在採購、供應商整合方面有機會。

On the OpEx side, we'll continue to expand into shared services in some of these low-cost areas where we have those. And then honestly, from OpEx, we have a lot of natural leverage. It just comes when you're growing at the rate that we're growing.

在營運支出方面，我們將繼續在一些我們擁有共享服務的低成本領域中拓展共享服務。老實說，從營運支出來看，我們有很多天然的槓桿作用。當你以我們的成長速度成長時，它就會出現。

Our next question will come from Ryan Zimmerman with BTIG.

我們的下一個問題將來自 BTIG 的 Ryan Zimmerman。

So I want to ask about orthopaedics. It's just been stellar performance, and we've heard from you and one of your peers. And Kevin, I just would appreciate if you can kind of characterize the confidence that this continues to persist for '24. And how are you improving or what are you doing to improve potentially productivity on the Mako unit to capture the demand that's continuing to be so strong?

所以我想問骨科的問題。這是一場出色的表現，我們收到了您和您的一位同事的來信。凱文，如果您能描述一下這種情況在 24 世紀持續存在的信心，我將不勝感激。您正在如何改善或正在採取哪些措施來提高 Mako 部門的潛在生產力，以滿足持續強勁的需求？

We're delighted with the progress that we've made. 60% of U.S. knees being done on the robot is pretty remarkable, given how long ago we launched the total knee application and seeing hips starting to really climb since we launched the 4.0 software has been terrific. Cementless continues to climb as well. And that tends to index much higher with the use of Mako. And as you know, we are clearly the leader in not just in robotic-assisted surgery, but clearly the leader in cementless as well.

我們對所取得的進展感到高興。考慮到我們很久以前就推出了全膝關節應用程序，並且自從我們推出4.0 軟體以來看到臀部開始真正爬升，這真是太棒了，美國60% 的膝蓋手術都是在機器人上完成的，這真是太了不起了。 Cementless 也持續攀升。使用 Mako 後，指數往往會更高。如你所知，我們顯然不僅是機器人輔助手術的領導者，而且顯然也是非骨水泥手術的領導者。

So a lot of good things going on with a market that is obviously a little better than it has been historically. But Mako continues to be the engine of growth, and that's true in the hospital. That's true in the ASCs as well. And we're seeing continued growth in ASC, where our Stryker offense is really winning at pretty spectacular rates as it relates to new builds and big renovations. So we have a lot of momentum across all of those dimensions, which translates to terrific performance as you saw with Hips and Knees.

因此，市場上發生了很多好事，顯然比歷史上的情況好一些。但 Mako 仍然是成長的引擎，在醫院也是如此。 ASC 也是如此。我們看到 ASC 的持續成長，我們的 Stryker 進攻確實以相當驚人的速度獲勝，因為它與新建和大型翻修有關。因此，我們在所有這些維度上都有很大的動力，這轉化為出色的表現，正如您在臀部和膝蓋上看到的那樣。

But the other part of our story is Trauma and Extremities. So the Wright Medical acquisition has been a complete home run of a deal, and you're seeing that. And not only has it been great for our Extremities business but enabled us to focus a lot more on our core Trauma business. And we really had all of our businesses in Trauma and Extremities humming as we exited the year and some great product launches towards the end of the year and some more to come in 2024.

但我們故事的另一部分是創傷和四肢。因此，對萊特醫療公司的收購是一次徹底的本壘打交易，您也看到了這一點。這不僅對我們的四肢業務有很大幫助，而且使我們能夠更加專注於我們的核心創傷業務。隨著今年的結束，我們在創傷和四肢領域的所有業務確實都在蓬勃發展，並在年底推出了一些出色的產品，並將在 2024 年推出更多產品。

Okay. And then maybe turning to Medical because it is now, I think, the biggest unit inside the company. And the comps are increasingly tougher in the first half of this year. It's been exemplary growth through late '22 and then in the first half of '23. Inside of that, you talked about Vocera continuing to be a double-digit grower. But if you can level set us on the entire portfolio, how do you think about the ability of that business to continue to be accretive to overall growth? And maybe what the appropriate expectations are around the Medical segment given how much is in that segment?

好的。然後也許會轉向醫療部門，因為我認為它現在是公司內部最大的部門。今年上半年的競爭越來越激烈。 22 年末和 23 年上半年的成長堪稱典範。其中，您談到 Vocera 繼續保持兩位數種植者的地位。但是，如果您可以對整個投資組合進行水平設定，您如何看待該業務繼續促進整體成長的能力？考慮到醫療細分市場的規模，也許該細分市場的適當期望是什麼？

Look, we love our Medical business. And frankly, it's become a big and very fast-growing business. We continue to expect it to grow above Stryker's average growth rate. That is going to be true for the next 5 years. From quarter-to-quarter, it does bounce around a little bit because, of course, there's capital. A lot of large capital within Medical, but you also have increasingly more stable revenue with Sage, which is doing [attack] as well. Then you've got obviously the AED demand, which has exploded, and we have a terrific AED business. Tremendous innovation. We launched the Xpedition stair chair in the early part of the year, the first powered stair chair, which the firehouses absolutely love. And then you've got a lot of new demand for the wireless connection, wireless stretchers.

看，我們熱愛我們的醫療業務。坦白說，它已經成為一項規模龐大且成長非常快的業務。我們繼續預期其成長將高於史賽克的平均成長率。未來五年也是如此。從季度到季度，它確實會出現一點反彈，當然，因為有資本。 Medical 內部有大量資金，但 Sage 的收入也越來越穩定，Sage 也在進行[攻擊]。顯然，AED 需求爆炸性成長，而且我們的 AED 業務非常出色。巨大的創新。我們在今年年初推出了 Xpedition 樓梯椅，這是第一款電動樓梯椅，深受消防局的喜愛。然後，您對無線連線、無線擔架產生了許多新的需求。

So just tremendous innovation, tremendous leadership position, and now a much more diverse set of businesses than we had historically. So I think Medical is the business in Stryker that's the most underestimated because AEDs are high growth, our power costs are high growth.

因此，只有巨大的創新、巨大的領導地位，以及現在比我們歷史上更多元化的業務。因此，我認為醫療是史賽克最被低估的業務，因為 AED 高速成長，我們的電力成本高速成長。

And now our bed business is doing really well behind ProCuity, and then you have Vocera in addition to that. So really, I would expect high growth from all of those different businesses, Sage, Vocera, beds, stretchers, AEDs because of innovation that we're constantly innovating. And we have a couple of big launches in Medical coming this year as well, so it's an exciting time to be at Medical.

現在我們的床業務在 ProCuity 的支援下表現非常好，此外還有 Vocera。因此，實際上，我預計所有這些不同的業務（Sage、Vocera、床、擔架、AED）都會實現高速成長，因為我們不斷創新。今年我們還將在醫療領域推出幾項重大產品，所以這是醫療領域令人興奮的時刻。

And we also have an outstanding leadership team. They've really focused on talent for years and years and years. And so I'm very bullish on Medical. And I think, again, whatever people have in their models, we've tended to beat in Medical if you go back for the last [6] years.

我們還擁有一支優秀的領導團隊。他們多年來一直非常注重人才。所以我非常看好醫療。我再次認為，無論人們的模型中有什麼，如果你回顧過去[6]年，我們往往會在醫學領域擊敗。

Our next question will come from Joanne Wuensch with Citi.

我們的下一個問題將來自花旗銀行的 Joanne Wuensch。

Very nice end to the year. I'm curious about where you are in your super cycle. And not to use sports analogy, but are you halfway through? Half time? Or you have a couple more innings to go? I know I'm mixing my metaphors there. And also, sort of similarly, AAOS, what should we be expecting for that?

非常美好的一年結束。我很好奇你處於超級週期的哪個階段。不要用運動類比，但你已經完成一半了嗎？中場休息？還是你還有幾局要打？我知道我在那裡混合了我的隱喻。而且，類似地，AAOS，我們對此應該期待什麼？

I'll take the first part, and then Jason can talk about AAOS. Look, I would say that our pipeline of innovation is incredibly strong. When I mentioned the term super cycle, that really was referring to, let's call them, big platform launches. But the reality is we're driving tremendous growth even in some of the divisions that don't have big platform growth launches, if you think about upper extremities, you think about foot and ankle.

我先講第一部分，然後 Jason 可以談談 AAOS。看，我想說我們的創新管道非常強大。當我提到超級週期這個詞時，它實際上指的是，我們稱之為大平台發布。但現實是，即使在一些沒有大型平台成長發布的部門，我們也在推動巨大的成長，如果你想到上肢，你就會想到腳和腳踝。

But I would say the big ones coming up, we have this Pangea launch within our core trauma business, which is a big platform launch. We have a new defibrillator that's coming, of course, pending FDA approval. It's a PMA device, but we're very excited. That's what I would call a big platform launch. We have Mako spine coming in the third quarter of this year. That's another big platform launch towards the end of the year. We have the Mako shoulder, and we have this product that we call CoPilot, which is a very exciting product that's going to be used by spine surgeons as well as neurosurgeons, which is within the same ecosystem as Mako and our Q navigation system.

但我想說的是即將到來的重大事件，我們在核心創傷業務中推出了 Pangea，這是一個大型平台的發布。當然，我們即將推出一款新的除顫器，等待 FDA 的批准。這是一個 PMA 設備，但我們非常興奮。這就是我所說的大型平台發布。我們將在今年第三季推出 Mako 脊椎。這是今年底推出的另一個大型平台。我們有Mako 肩部，還有我們稱之為CoPilot 的產品，這是一款非常令人興奮的產品，將由脊椎外科醫生和神經外科醫生使用，它與Mako 和我們的Q 導航系統位於同一生態系統內。

So those are the ones I'd point out to, but what I'd tell you is every business has launches planned. And as some of them accumulate a number of small launches, then you end up driving pretty terrific growth. But I would say maybe we're kind of midway through the large platforms.

這些是我要指出的，但我要告訴你的是，每個企業都有推出計畫。當他們中的一些人累積了一些小規模的發佈時，你最終會推動相當驚人的成長。但我想說，也許我們正處於大型平台的中間。

But I would tell you, everyone is reloading. So we launched 1788, and they're reloading and already working on 1888. So I think we've just hit a sort of a cadence of innovation that's as good as it's ever been in my time at Stryker. And so I don't expect that we're going to sort of come off this super cycle and suddenly have some kind of a dip. We're just reloading and reloading, and getting back on M&A offense also will help to continue to fuel that. So I'm very, very bullish really for the next couple of years that this innovation pipeline across our company will continue to fuel high-end growth for Stryker. And second part, Jason?

但我會告訴你，每個人都在重新加載。所以我們推出了 1788，他們正在重新加載並已經在開發 1888。所以我認為我們剛剛達到了一種創新節奏，這是我在 Stryker 工作期間所經歷過的最好的創新節奏。因此，我預計我們不會在擺脫這個超級週期後突然出現某種下滑。我們只是不斷地重新加載，重新發起併購進攻也將有助於繼續推動這一趨勢。因此，我非常非常看好未來幾年我們公司的創新管道將繼續推動史賽克的高端成長。第二部分，傑森？

Joanne, it's Jason. Happy to follow up after the call as well. But AAOS will be exciting. Some of the products that Kevin just referred to, we will be demoing at AAOS. Starting with Blueprint, followed by Pangea, 1788 camera will also be demoed as well. So it will be action-packed, so we plan on seeing you out there.

喬安妮，是傑森。通話後也很樂意跟進。但 AAOS 將會令人興奮。 Kevin 剛才提到的一些產品，我們將在 AAOS 上進行示範。首先是 Blueprint，隨後是 Pangea，1788 相機也將進行展示。所以這將是充滿動感的，所以我們計劃在那裡見到你。

Our next question will come from Vijay Kumar with Evercore ISI.

我們的下一個問題將來自 Evercore ISI 的 Vijay Kumar。

Congrats on a really strong print here. I had 2 questions. Maybe first one on the guidance here. 7.5% to 9% for the fiscal '24, what is being assumed for China VBP? Any backlog contribution? And I'm looking at Q1, that's the toughest comp of the year. Should Q1 still be within that annual guidance range of 7.5% to 9%?

恭喜這裡的列印效果非常好。我有兩個問題。也許是這裡的第一個指南。 24 財年的成長率為 7.5% 至 9%，中國 VBP 的假設是什麼？有積壓貢獻嗎？我正在關注第一季度，這是今年最艱難的比賽。第一季是否仍應在 7.5% 至 9% 的年度指引範圍內？

Vijay, yes, as we look at -- I don't want to guide quarterly, but I would tell you that the cadence of what we're going to deliver from the midpoint will play out similar to 2023. But keep in mind, you got to back out 1 selling day in Q1 is what I would say. And then on VBP, I'll let Jason...

Vijay，是的，正如我們所看到的——我不想按季度提供指導，但我會告訴你，我們從中點開始交付的內容的節奏將與 2023 年類似。但請記住，我想說的是，你必須取消第一季的1 個銷售日。然後在 VBP 上，我會讓 Jason...

Yes, I mean -- it's Jason. On VBP, I think we don't disclose in terms of the impact there, so we won't. But in terms of a follow-up to your capital question, as we think about the capital environment, really the tone has not changed there. We feel really good. Orders are very healthy. I mentioned that we came into the year with an elevated level, so we feel good. And just as a reminder, right, if you think about our capital sales, so our smaller capital being, call it, 15% of our sales needs to continue to be refreshed as you think about kind of the procedural volume. And then large capital being 10% of our sales, again, very healthy from both a order and backlog perspective. So we feel good about that in 2024.

是的，我是說──這是傑森。關於VBP，我認為我們不會透露那裡的影響，所以我們不會。但就你的資本問題的後續而言，當我們考慮資本環境時，實際上基調並沒有改變。我們感覺真的很好。訂單非常健康。我提到我們進入這一年的水平很高，所以我們感覺很好。提醒一下，對吧，如果你考慮我們的資本銷售，那麼我們較小的資本，稱之為，當你考慮程序量時，我們的銷售額的 15% 需要繼續刷新。然後，大資本占我們銷售額的 10%，從訂單和積壓的角度來看，這都是非常健康的。所以我們對 2024 年的情況感到滿意。

Understood. And Kevin, maybe one for you on that. I saw that you mentioned direct-to-consumer campaign on Mako is very successful. Could you just elaborate on that? And I'm curious, do you think like on the Spine side, we could perhaps see adoption rates similar to Knee, where 50%, 60% of spine procedures could be done in Mako at some point in the future?

明白了。凱文（Kevin），也許是適合你的一個。我看到您提到 Mako 上的直接面向消費者的活動非常成功。能詳細說明一下嗎？我很好奇，您是否認為在脊椎方面，我們也許會看到類似於膝蓋的採用率，在未來的某個時候，50%、60% 的脊椎手術可以在 Mako 中完成？

Well, first, the direct-to-consumer has been terrific. I mean obviously, we have such a lead in robotic-assisted surgery. We want to make sure that we're differentiating our product among the rest of products, and the searches and the impressions that we have kind of exceeded our expectations. So we're really pleased, we're going to continue that program for a good portion of this year. And so that certainly helped create a tremendous interest among consumers as well as hospitals, who actually watch the same ads as consumers, so we're very excited about that.

嗯，首先，直接面向消費者的效果非常棒。我的意思顯然是，我們在機器人輔助手術方面處於領先地位。我們希望確保我們的產品在其他產品中脫穎而出，並且我們的搜尋和印象超出了我們的預期。所以我們真的很高興，我們將在今年的大部分時間裡繼續該計劃。因此，這無疑引起了消費者和醫院的巨大興趣，他們實際上與消費者觀看相同的廣告，因此我們對此感到非常興奮。

Spine, we couldn't be more happy because certainly, that's been a gap in our portfolio relative to others. And this has got terrific workflow. And look, I think robotic adoption tends to really grow no matter what procedure you're doing. If you have a good solution, it will, over time, become the majority and eventually standard of care. And we've obviously seen this in the general surgery world, as it relates to prostate, and starting to happen in other cases. And I think it's going to happen in orthopaedics. And so Spine might take a little longer, but I absolutely do believe it's going to be key for us in the future.

Spine，我們非常高興，因為當然，這是我們的投資組合相對於其他人的差距。這有很棒的工作流程。看，我認為無論你在做什麼手術，機器人的採用都會真正增長。如果你有一個好的解決方案，隨著時間的推移，它將成為大多數護理方法並最終成為標準。我們顯然已經在普通外科領域看到了這一點，因為它與前列腺有關，並且開始在其他病例中發生。我認為這將會發生在骨科領域。因此 Spine 可能需要更長的時間，但我絕對相信它將成為我們未來的關鍵。

We're extremely excited. We've been showing surgeons the Mako spine, getting terrific feedback on the workflow and the speed and the efficiency. And again, that's within the same ecosystem as the Q Guidance. So we've been selling a lot of Q Guidance software, which is used to navigate those procedures. And that same camera, which is the fastest camera in the market, will be compatible with Mako when we launch it. So I do believe it will become, for pedicles replacement at least, the vast majority of the procedures in the future.

我們非常興奮。我們一直在向外科醫生展示 Mako 脊柱，並獲得了有關工作流程、速度和效率的極好的反饋。再說一遍，它與 Q Guidance 屬於同一生態系統。因此，我們一直在銷售大量 Q Guidance 軟體，該軟體用於導航這些程式。當我們推出這款相機時，它是市場上速度最快的相機，它將與 Mako 相容。所以我確實相信，至少對於椎弓根置換術來說，它將成為未來絕大多數手術的一部分。

Our next question will come from Shagun Singh with RBC.

我們的下一個問題將由加拿大皇家銀行的 Shagun Singh 提出。

Kevin, I was hoping to get your thoughts on utilization. It's been a key topic this last week across some health care sectors. What trends are you seeing in health care utilization across different care settings? What is driving it? And how do you think about the sustainability of it? Is it being driven by the aging demographics? Is it innovation? Is it just low market penetration? And I think you did indicate that there is still a backlog and it is contributing. But is it a meaningful contributor to growth on a year-over-year basis? And then I have a follow-up.

凱文，我希望了解您對利用率的想法。這是上週一些醫療保健行業的關鍵話題。您認為不同照護環境中醫療保健利用的趨勢是什麼？是什麼在驅動它？您如何看待它的可持續性？這是由人口老化所推動的嗎？是創新嗎？只是市場滲透率低嗎？我認為您確實表明仍然存在積壓，並且正在做出貢獻。但它是否對年成長做出了有意義的貢獻？然後我有一個後續行動。

Okay. Well, I think if you look at the hospitals and what they're saying, that's kind of one of the indicators we look at, they're busy, right? The hospitals are busy. Patients are -- definitely, aging demographics plays for Stryker's portfolio. That definitely plays to our advantage. And every day, 10,000 more people are turning 65. The activity levels are also increasing, right? The advent of pickle ball has been a terrific thing for our business. More active people who are elderly tend to want to stay active, and activity levels are kind of the biggest predictor of needing joint replacements and Sports Medicine procedures. And so we're seeing very good activity levels.

好的。好吧，我想如果你看看醫院以及他們所說的話，這就是我們關注的指標之一，他們很忙，對嗎？醫院很忙。病人－毫無疑問，人口老化對史賽克的產品組合至關重要。這絕對對我們有利。每天，都有 10,000 人迎來 65 歲生日。活動量也在增加，對吧？泡菜球的出現對我們的業務來說是一件了不起的事。較活躍的老年人往往希望保持活躍，而活動量是需要關節置換和運動醫學手術的最大預測因子。所以我們看到了非常好的活動量。

And so I don't really want to talk about backlog. I just think what we're seeing is patients presenting -- frankly, some patients who are just wanting to be more active, losing weight, and then wanting to be more active and then being eligible for surgery. So we do see really good -- a waiting list for surgeries, for surgeons in the orthopaedic space. Hospitals ordering capital, whether it's small capital or large capital, building more ASCs. The ASC trend has actually really helped because patients love it. They go, they get home the same day. They have a terrific experience, and they tell all their friends. And that word of mouth is spreading for hip and knees. Absolutely, for hip-and-knee surgeries, that is happening. And our percent of procedures in ASCs continues to climb.

所以我真的不想談積壓的問題。我只是認為我們看到的是患者的表現——坦白說，有些患者只是想要更活躍，減肥，然後想要更活躍，然後才有資格接受手術。所以我們確實看到了很好的結果——整形外科領域的外科醫生等待手術的名單。醫院訂購資本，無論是小資本或大資本，建立更多的 ASC。 ASC 趨勢實際上確實有幫助，因為患者喜歡它。他們走了，當天就回家了。他們有一次很棒的經歷，並告訴了他們所有的朋友。這種口碑正在傳播到臀部和膝蓋。當然，對於髖關節和膝關節手術來說，這種情況正在發生。我們在 ASC 的手術比例持續攀升。

So I think those are -- there's a number of factors I just outlined, all of them pointing to this, at least for this year, continued good demand. And I'm not -- I don't know that it's -- I don't know how temporary it is. This could be continuing, frankly, for a period of time because I think demographics and activity levels are the 2 drivers that we're seeing, at least for our portfolio of businesses.

所以我認為，我剛才概述了許多因素，所有這些因素都表明，至少在今年，需求持續良好。我不——我不知道它是——我不知道它有多短暫。坦白說，這種情況可能會持續一段時間，因為我認為人口統計和活動水平是我們看到的兩個驅動因素，至少對於我們的業務組合而言。

That's really helpful. And then just on guidance, you guys delivered a pretty -- or you put up a pretty strong initial guide out of the gates. Does it give you room for upside as you move through the year? And I guess more specifically, what areas could we potentially look to drive that upside?

這真的很有幫助。然後，僅僅根據指導，你們就提供了一個漂亮的——或者你們提供了一個非常強大的初始指南。當你度過這一年的時候，它會給你上升的空間嗎？我想更具體地說，我們可以在哪些領域尋求推動這一上升趨勢？

Great question. First of all, we have a history that we generally like to follow. And I would tell you that it's early days. We're here in January looking at 2024. We feel very confident about where we're going to perform on sales and driving op margin expansion. At this point, I'm not going to comment on the potential to go beyond that. But we feel very good about the guidance that we put out.

很好的問題。首先，我們有一段我們普遍喜歡遵循的歷史。我想告訴你，現在還太早。我們在一月展望 2024 年。我們對銷售業績和推動營運利潤率擴張非常有信心。在這一點上，我不會評論超越這一點的潛力。但我們對我們提出的指導感到非常滿意。

Our next question will come from Pito Chickering with Deutsche Bank.

我們的下一個問題將來自德意志銀行的 Pito Chickering。

Congrats on an amazing year. On the gross margins, can you help bridge the third quarter to fourth quarter gross margins? How much of the impact was mix? And then you have the good guys and bad guys, if you can help us understand that sequential change?

恭喜您度過了精彩的一年。在毛利率方面，您能幫助彌補第三季和第四季的毛利率嗎？混合的影響有多大？然後還有好人和壞人，你能幫助我們理解這種連續的變化嗎？

Yes. Sure, Pito. Without going into too much detail, I would say the single biggest item was really mix in terms of what was growing much faster in Q4 versus Q3, relative to sort of some of the other items. We also had really solid price performance in Q4, which contributed to that. And then lastly, in sort of in typical Stryker fashion, we hit a little bit of a hockey stick here in Q4 too. And so that actually benefits on the gross margin line.

是的。當然，皮托。在不涉及太多細節的情況下，我想說，相對於其他一些項目，第四季度與第三季度增長速度更快的項目確實是混合的。我們在第四季的價格表現也非常穩定，這也是這一點的原因。最後，以典型的史賽克風格，我們在第四季也遇到了一些曲棍球棒。因此，這實際上有利於毛利率。

Okay. Great. And then on pricing, back in third quarter, I think it was about 30 basis points favorable. It's 70 basis points favorable this quarter. Guidance assumes flat pricing for '24. I guess, shouldn't there be some positive pricing in '24 just as the fourth quarter comps out? And after you've gotten accelerating pricing throughout the year, I guess, why is your 2024 pricing flattened out?

好的。偉大的。然後在定價方面，回到第三季度，我認為大約有 30 個基點的優惠​​。本季有利 70 個基點。指導假設 24 年採用統一定價。我想，就像第四季的業績一樣，24 年不應該有一些正面的定價嗎？我想，在全年定價加速之後，為什麼 2024 年的定價會趨於平緩？

Keep in mind, flat is the average for the whole company. And the way that, that pricing guide is calculated is legacy product over legacy product. So a lot of our pricing increases carry over into 2024. They're just comparing to the new higher price. I would also say too that flat is the average of some up and some down, and so we absolutely will see price increases across some of our businesses. And that will be balanced with some of the challenges we have in, say, spine or some of our other orthopaedic businesses. So I do think we haven't backed off our pricing strategy one bit, and we fully expect to sort of maximize the benefit we're going to get out of pricing.

請記住，持平是整個公司的平均水平。定價指南的計算方式是舊產品優於舊產品。因此，我們的許多定價上漲都會延續到 2024 年。它們只是與新的更高價格進行比較。我還想說，持平是一些上漲和一些下跌的平均值，因此我們絕對會看到我們一些業務的價格上漲。這將與我們在脊椎或其他一些骨科業務方面面臨的一些挑戰相平衡。因此，我確實認為我們並沒有放棄我們的定價策略，我們完全希望能夠最大限度地提高我們從定價中獲得的收益。

Our next question will come from Travis Steed with Bank of America.

我們的下一個問題將來自美國銀行的 Travis Steed。

Glenn, maybe just a finer point on some of the op margin guide. It looks like the 200 basis points, more than half of that is in 2024. Can you just confirm that? There's a little bit of kind of math going around. I just want to make sure we got the math in '24 correct. And then with such a big ramp in '24 on the guidance, just can you give a little more confidence on what you're doing to kind of achieve that 100 basis points plus in 2024 from what you're seeing on the cost input side? Just to kind of drive confidence that that's achievable in '24?

格倫，也許只是關於一些操作保證金指南的更詳細的觀點。看起來是200個基點，其中一半以上是在2024年。你能證實一下嗎？這裡有一些數學知識。我只是想確保我們 24 年的數學計算是正確的。然後，隨著 24 年指引的大幅成長，您能否對自己正在做的事情更有信心，從成本投入方面看到，到 2024 年實現 100 個基點以上？只是為了增強人們對 24 年可以實現這一目標的信心嗎？

Yes, I think you can do the math as well as I can, especially given all the areas that I've guided in the full year. So I definitely think you're in the ZIP code for what we think will happen in 2024. And honestly, if we look at sort of what we've laid out and planned for the year, first of all, the natural leverage we get from growth versus fixed cost and operating expenses certainly will provide us some benefit. We also won't stand still in a lot of the gross margin initiatives that I mentioned, and those will move forward and also provide some benefit that we'll see in 2024. And so I would tell you that we haven't walked lightly on this. I would say that across the globe, Stryker is very focused on these op margin expansion projects and sustainable op margin expansion for 2024 and 2025. And so we feel very confident that we'll be able to deliver that.

是的，我認為你可以像我一樣做數學，特別是考慮到我全年指導的所有領域。所以我絕對認為你在我們認為 2024 年會發生的事情的郵政編碼中。老實說，如果我們看看我們今年的佈局和計劃，首先，我們獲得的自然槓桿增長與固定成本和運營費用的比較肯定會為我們帶來一些好處。我們也不會在我提到的許多毛利率舉措上停滯不前，這些舉措將會向前推進，並為我們帶來一些我們將在2024 年看到的好處。所以我想告訴你們，我們並沒有輕言放棄關於這一點。我想說，在全球範圍內，Stryker 非常關注這些營運利潤擴張項目以及 2024 年和 2025 年的可持續營運利潤擴張。因此，我們非常有信心能夠實現這一目標。

Great. And then maybe one quick question on Mako shoulder just to make sure that's still expected to come in 2024. And anything else you want to say on that at this point?

偉大的。然後，也許可以向 Mako 提出一個簡單的問題，以確保這一情況仍有望在 2024 年實現。此時您對此還有什麼想說的嗎？

Yes. Listen, as we've said from the beginning, Mako shoulder will launch at the end of '24. So don't expect to have much at all of a revenue impact. That said, [it's] something like our shoulder business needs, Mako shoulder to be growing at strong double digits. They have terrific products within upper extremities, with Shoulder iD, with a number of really pyrocarbon humeral. We have a fracture stem for Perform, which is incredible, a reverse Perform stemless. So we have 4 terrific launches in upper extremity, so they're going to be fine even before Mako. But Mako will be the end of the year. The feedback from surgeons have been terrific, but that will have much more of an impact in '25, not so much in '24.

是的。聽著，正如我們從一開始就說過的，Mako 肩膀將於 24 年底推出。因此，不要指望會對收入產生太大影響。也就是說，[這]就像我們的肩部業務需求，Mako 肩部以強勁的兩位數增長。他們在上肢方面擁有出色的產品，包括肩部 iD，以及許多真正的熱碳肱骨。我們有一個用於 Perform 的骨折柄，這是令人難以置信的，相反的 Perform 無柄。所以我們在上肢有 4 次出色的發射，所以即使在 Mako 之前它們也會很好。但 Mako 將會在今年底到來。外科醫生的回饋非常好，但這將在 25 年產生更大的影響，而不是在 24 年產生太大影響。

Our next question will come from Matthew O'Brien with Piper Sandler.

我們的下一個問題將由馬修·奧布萊恩和派珀·桑德勒提出。

Just on Mako, this question might be for Jason. Just the domestic number this quarter was a little bit soft, and we're hearing about one of your competitors just giving their system away, so it's not all that great. Can you talk about the dynamics that you're seeing in the market, especially domestically for Mako in terms of placing systems, selling systems, and then just having to get really aggressive on the pricing side, just given the environment that you're in? And then conversely, the OUS number looks phenomenal again. Just where are we at in terms of growing that business over the next several years? And I do have one follow-up.

就 Mako 而言，這個問題可能是問 Jason 的。只是本季的國內數據有點疲軟，而且我們聽說你們的一個競爭對手只是放棄了他們的系統，所以情況並不是那麼好。您能否談談您在市場上看到的動態，尤其是 Mako 在國內的放置系統、銷售系統，然後考慮到您所處的環境，在定價方面必須變得非常激進？相反，OUS 的數字看起來再次驚人。未來幾年我們的業務發展處於什麼階段？我確實有一個後續行動。

Matt, I'll start this and Kevin, feel free, obviously, to weigh in. But as we think about the Mako offense, and I think we've said this previously as well, when we think about the various options to bring Mako to market, we've been flexible, right, whether it's leasing, rental, et cetera. So I think we're very competitive from that standpoint. And to your comment on kind of where we are, I would still say whether it's U.S. or internationally, early innings here. We've got a lot of runway relative to Mako. But as we think about the financing options, it's not going to be an impediment for us to expand the Mako footprint.

馬特，我會開始這個，凱文，顯然，請自由地發表意見。但是當我們考慮馬科進攻時，我想我們之前也說過這一點，當我們考慮引進馬科的各種選擇時到市場上，我們一直都很靈活，對吧，無論是租賃、出租等等。所以我認為從這個角度來看我們非常有競爭力。對於您對我們所處位置的評論，我仍然會說，無論是美國還是國際比賽，這裡都處於早期階段。相對於 Mako，我們有很多跑道。但當我們考慮融資方案時，它不會成為我們擴大 Mako 足跡的障礙。

Yes. The only thing I would add to Jason's comments are that every ASC Mako that's installed is financed. Every one. And that's becoming a bigger percentage of the Mako installations. So what you're seeing is more financed rentals and financed versus outright capital purchases. So that, obviously, the revenue number and the revenue growth of 3% in the U.S. is not installation growth. Installation growth is higher than what you're seeing. And over time, that will start to normalize and then you'll start to see the growth rate to be more reflective of the installation rate. But we're going through this kind of transition phase right now.

是的。我對 Jason 的評論唯一要補充的是，每個安裝的 ASC Mako 都有資金支持。每個人。這在 Mako 安裝中所佔的比例越來越大。因此，您所看到的是更多融資租賃和融資與直接資本購買相比。因此，顯然，美國 3% 的營收成長並不是安裝量的成長。安裝增長速度比您看到的要高。隨著時間的推移，這種情況將開始正常化，然後您將開始看到成長率更能反映安裝率。但我們現在正在經歷這種過渡階段。

And we aren't giving them away. So we charge for it. We have different pricing models, obviously. And we want the customers to have skin in the game. So that -- if we just give it away, they have no incentive to use it. And what we don't want are a bunch of robots collecting dust. So we care a lot and we monitor utilization of the robots very, very significantly.

我們不會放棄它們。所以我們要收費。顯然，我們有不同的定價模式。我們希望客戶能夠參與其中。因此，如果我們只是將其贈送出去，他們就沒有動力使用它。我們不要的是一群收集灰塵的機器人。所以我們非常關心，並且非常非常密切地監控機器人的使用情況。

And then, of course, OUS, we're seeing terrific pickup and a lot more purchases than finance. We do offer financing around the world. But so far, in international, we're seeing a lot more purchases than we are financing, which is why you see the revenue spike. But again, international has a huge potential. It's kind of where we were in the U.S. about 5 years ago.

然後，當然，OUS，我們看到了驚人的成長和比金融更多的購買。我們確實在世界各地提供融資。但到目前為止，在國際上，我們看到的購買量比我們的融資量要多得多，這就是您看到收入激增的原因。但同樣，國際化具有巨大的潛力。這有點像我們五年前在美國的情況。

Understood. And then sticking with Mako. Kevin, you mentioned shoulder. You don't really need the application as much because you're crushing it on the shoulder side. In spine, you're doing better in the last couple of quarters. I haven't really heard why that is. I don't know if it's just on the dislocation or not. But I think it's probably a bigger opportunity on the spine side of the business going forward. These centers that already have Mako and use them for hips and knees, can you quickly transfer the system to the spine part of those institutions or facilities and start to pick up share fairly quickly? Or is this something that's going to take many, many quarters? We're talking '25, '26 before it really starts to impact the Spine business?

明白了。然後就和 Mako 在一起了。凱文，你提到了肩膀。您實際上並不那麼需要該應用程序，因為您正在將其壓在肩側。在脊椎方面，你在過去幾季做得更好。我還沒有真正聽說這是為什麼。不知道是不是只是脫臼了。但我認為這對於未來業務的發展來說可能是一個更大的機會。這些中心已經擁有 Mako 並將其用於臀部和膝蓋，您能否快速將系統轉移到這些機構或設施的脊柱部分並開始相當快地獲得份額？或者這需要很多很多季度的時間？我們正在談論“25、26 年”，然後它才真正開始影響 Spine 業務嗎？

What I'd say is, first of all, the Mako brand is extremely well known. That's a very, very big positive. And I think what you're going to see is a much faster uptake than you would have seen had we not had already had Mako on hips and knees. Will it take a little bit of time? Sure. Well, let's find a surgeon who want to share the robot with hips-and-knees surgeons. Not sure yet. Obviously, that's something we're going to see play out, whether they're going to want their own robot or they're going to be willing to operate on the days that hip-and-knee people aren't operating. So that's a whole dynamic, I think, that will vary account by account.

我想說的是，首先，Mako 品牌非常知名。這是一個非常非常大的正面因素。我認為，如果我們沒有在臀部和膝蓋上使用 Mako，您將看到的吸收速度比您看到的要快得多。會需要一點時間嗎？當然。好吧，讓我們找到一位願意與臀部和膝蓋外科醫生共享機器人的外科醫生。尚未確定。顯然，這是我們將看到的事情，無論他們是想要自己的機器人，還是願意在髖關節和膝關節不活動的日子裡進行手術。我認為，這是一個整體動態，會因帳戶而異。

So we're already working on our commercialization plans. I think part of the reason for our success is success of the Q Guidance, which is 1/2 of the system. So you have the Q Guidance and as well Mako, they know it's coming now. Customers have gone to Leesburg, Virginia, our spine headquarters, to see Mako spine. And many of them have stopped their purchases of other robots, knowing that this is coming. So I think that's what's helping to contribute to our, let's call it, somewhat improved performance. But we still would like to grow at a higher rate than we are right now. And we know we need not just Mako but also the CoPilot product, so we're going to go from being behind to being ahead. And CoPilot should launch in a similar time frame, slightly ahead of Mako spine, so you're now going to have the CoPilot product plus the Mako spine, where our subpar competitors will just have their robot. The ones that have robot will just have a robot, without CoPilot with haptic feedback that can do the laminectomy and discectomy portions of the procedure, which complements the pedicle screw placement.

所以我們已經在製定我們的商業化計劃。我認為我們成功的部分原因是Q Guidance的成功，它佔系統的1/2。所以你有 Q Guidance，還有 Mako，他們知道它現在就要來了。客戶已前往我們的脊椎總部弗吉尼亞州利斯堡參觀 Mako 脊椎。他們中的許多人已經停止購買其他機器人，因為他們知道這即將到來。所以我認為這有助於我們（我們可以稱之為）稍微提高效能。但我們仍然希望以比現在更高的速度成長。我們知道我們不僅需要 Mako，還需要 CoPilot 產品，因此我們將從落後變為領先。 CoPilot 應該在相似的時間範圍內推出，略早於 Mako spin，所以您現在將擁有 CoPilot 產品和 Mako spin，而我們的低於標準的競爭對手將只擁有他們的機器人。擁有機器人的人只會擁有一個機器人，沒有帶有觸覺回饋的副駕駛，可以完成手術的椎板切除術和椎間盤切除術部分，這對椎弓根螺釘的放置起到了補充作用。

So we're really going to be in a great position by the time third quarter comes around. Robots do take time, so the scaling will take time. But I think it will be certainly much faster than the initial people who came in with robotics. And they know they benefit from it, and they know they can trust the Mako brand.

因此，到第三季到來時，我們確實將處於有利地位。機器人確實需要時間，所以規模化也需要時間。但我認為它肯定會比最初使用機器人技術的人快得多。他們知道自己可以從中受益，也知道可以信任 Mako 品牌。

Our next question will come from the line of Josh Jennings with TD Cowen.

我們的下一個問題將來自 Josh Jennings 和 TD Cowen 的對話。

I wanted to, hopefully, Kevin, ask about just get a temperature check on the health care delivery systems capacity for orthopaedic procedure growth. I think heading into '23 after experiencing 2022, there were concerns around staffing shortages, et cetera, and potentially creating a bottleneck for procedure volume growth. That clearly didn't play out in 2023. It doesn't sound like from your comments, it's going to play out. You expect it to play out in 2024. But are there any capacity constraint issues in the U.S. health care delivery system for orthopaedic procedure volume growth as we go forward in '24 and '25? Or is that fully in the rearview mirror?

凱文，我希望對醫療保健服務系統的骨科手術發展能力進行溫度檢查。我認為，在經歷了 2022 年後，進入 23 年，人們擔心人員短缺等問題，並可能造成手術量增長的瓶頸。這顯然不會在 2023 年發生。從你的評論來看，這不會發生。您預計它將在 2024 年發揮作用。但是，隨著 24 世紀和 25 年的發展，美國醫療保健服務系統是否存在骨科手術數量增長的能力限制問題？或者這完全在後視鏡中？

Yes, I think it's largely in the rearview mirror. There's still niggling things here and there, but it's gotten very quiet. You saw that in Q4. It's just a boomer of a Q4. And the kind of the normal seasonality, I think we now have finally a normalized year for you to compare against, of course, adjusted for selling days. But there is a normalized year finally. And yes, they've gotten their staffing issues solved largely, and they do prioritize orthopaedics because orthopaedics is a money maker for hospitals, right? Cardiovascular and orthopaedic procedures are the 2 money makers.

是的，我認為這主要是在後視鏡。雖然還有一些瑣事，但已經很安靜了。你在第四季就看到了這一點。這只是第四季的嬰兒潮世代。至於正常的季節性，我認為我們現在終於有了一個標準化的年份供您進行比較，當然，根據銷售天數進行了調整。但終於迎來了正常化的一年。是的，他們已經在很大程度上解決了人員配備問題，而且他們確實優先考慮骨科，因為骨科是醫院的賺錢工具，對嗎？心血管和骨科手術是兩個賺錢的領域。

And so if they are short staffed, they are going to prioritize staffing for orthopaedics. I would say the only area that still has a lot of room to run is ASCs. So every hospital is constructing ASCs, and that's going to continue to be an engine of future growth. But I'd say we're in a very normalized environment. They have the capacity. They can operate additional days, which we saw some of that in Q4 again, which we hadn't seen for a couple of years. So I think the hospitals are absolutely ready now, and a lot of that is behind us.

因此，如果他們人手短缺，他們將優先考慮骨科人員。我想說，唯一還有很大發展空間的領域是 ASC。因此，每家醫院都在建造 ASC，這將繼續成為未來成長的引擎。但我想說我們處於一個非常正常化的環境。他們有能力。他們可以額外運營幾天，我們在第四季度再次看到了這種情況，這是我們幾年來沒有見過的。所以我認為醫院現在已經完全準備好了，很多事情都已經過去了。

Excellent. Just one follow-up on Mako. Just another record system placement quarter. Was hoping to just get some details on where -- what you're seeing in terms of second or even third system purchases by hospitals, hospital systems. Any kind of percentage of total systems? Or how big of an opportunity do you see kind of getting that second, third, maybe even fourth system into hospitals?

出色的。只是 Mako 的後續行動。這又是一個記錄系統安置季度。希望能得到一些關於醫院、醫院系統購買第二甚至第三系統的細節。佔整個系統的百分比嗎？或者您認為將第二個、第三個、甚至第四個系統引入醫院有多大的機會？

Josh, it's Jason. First, I would say there are many hospital systems across the U.S. that are second, third system. For competitive reasons, we don't disclose kind of number of units installed. But you certainly see numerous systems with multiple Makos. I think as you fast forward to a shoulder and spine application, you're going to see more and more of that when you think about utilization and the need for future systems. So that's kind of how we think about that.

喬什，是傑森。首先，我想說，美國有很多醫院系統是第二、第三系統。出於競爭原因，我們不會透露安裝的設備數量。但您肯定會看到許多具有多個 Mako 的系統。我認為，當您快轉到肩部和脊椎應用時，當您考慮利用率和未來系統的需求時，您會看到越來越多的情況。這就是我們的想法。

Yes. Frankly, I would say it's rare to have one Mako in a hospital now. There are some that have 5, 6, 7 Makos. I think 60% of our knees are going to Mako. That's got to be a lot of Makos to be able to drive that kind of volume. So the days of people saying, well, this is my first Mako, those days in the U.S. are kind of fading. That phenomenon still exists outside the U.S.

是的。坦白說，我想說現在醫院裡很少有一個 Mako。有些有 5、6、7 個 Mako。我認為我們 60% 的膝蓋都會受到 Mako 的影響。必須有很多 Mako 才能推動這種數量。所以人們說，好吧，這是我的第一個 Mako，那些在美國的日子已經過去了。這種現像在美國以外仍然存在

Our next question will come from Chris Pasquale with Nephron.

我們的下一個問題將來自克里斯·帕斯誇萊（Chris Pasquale）和尼弗龍（Nephron）。

Just quickly on the SERF acquisition. Are there any particular portfolio gaps you closed with that deal? Or is it more about expanding your distribution footprint internationally?

快速了解 SERF 收購。透過該交易，您是否彌補了任何特定的投資組合缺口？或者更多的是為了擴大您的國際分銷足跡？

Chris, it's Jason. And we'll talk about this more after the close. But it really is -- it helps from a hip portfolio perspective. But beyond that, we haven't said much at this point. And like I said in my prepared remarks, we're set to close this quarter, and then we'll certainly talk more to that.

克里斯，是傑森。我們將在結束後進一步討論這一點。但事實確實如此——從時尚投資組合的角度來看，它很有幫助。但除此之外，我們目前還沒有說太多。正如我在準備好的發言中所說，我們將在本季度結束，然後我們肯定會對此進行更多討論。

And then I'm curious how you're thinking about the outlook for Neurovascular in '24. '23 was a better year for that segment in the U.S., but it kind of got offset by international. And along with Spine, it was really one of only 2 segments not to grow high single digits or better. So what's the game plan to drive better growth in that business? And do you have what you need internally? Or do you need to look for supplements to that?

然後我很好奇你如何看待 24 年神經血管的前景。 23 年對美國的這個細分市場來說是更好的一年，但它在某種程度上被國際市場所抵消。與 Spine 一樣，它確實是僅有的兩個沒有實現高個位數或更高成長的細分市場之一。那麼推動該業務更好成長的遊戲計畫是什麼？你內部有你需要的東西嗎？或是需要尋找補充嗎？

Look, we continue to like the neurovascular market, as there's still a large number of patients that aren't being treated. It's an attractive market growing high single digits. And we do expect to grow in line, at least in line with the market. We are obviously very hard hit by China this year with the VBP. We had a very big neurovascular business in China, so that hurt. I don't know that we completely lapped it, but it's going to -- we're going to get to the bottom of China pretty soon, and then that will be behind us.

看，我們繼續看好神經血管市場，因為仍有大量患者沒有接受治療。這是一個極具吸引力的市場，正以高個位數成長。我們確實預期會同步成長，至少與市場同步。今年，我們顯然受到了中國 VBP 的嚴重打擊。我們在中國有一個非常大的神經血管業務，所以這很受傷。我不知道我們是否完全接受了它，但我們很快就會深入中國的底部，然後那一切就會被拋在腦後。

We also have the SERF acquisition, which is off to a very good start outside the United States. We are seeking U.S. approval. I believe that will be some time in 2025, maybe beginning of '26. So we still have a bit of time to wait for that, but that is a fabulous product for intrasaccular technology.

我們也收購了 SERF，這在美國以外的地區取得了良好的開端。我們正在尋求美國的批准。我相信那會是 2025 年的某個時候，也許是 26 年初。所以我們還有一點時間等待，但這是囊內技術的絕佳產品。

We are looking at an area like liquid embolics. We don't have that product, if you want to think about one that we are going to be looking into. Every business has something they'd like to add. But we do have a good pipeline. We don't talk about Neurovascular pipeline too much because they get subject to regulatory approval through a PMA process. So -- but the team does have some very good products that are lining up. And I do believe we're going to be back to kind of much closer market growth, slightly above market growth in the years ahead. But as the market continue to [like], it obviously has gotten much more competitive on the ischemic side, and we continue to have a very strong business on the hemorrhagic side. We launched a couple of products last year, the Vecta 46 catheter, the Tetra coil, and that kind of fueled some very good U.S. growth as you saw in the back half of the year.

我們正在研究像液體栓塞這樣的區域。如果您想考慮我們將要研究的產品，我們沒有該產品。每個企業都有他們想要添加的東西。但我們確實有很好的管道。我們不會過多談論神經血管管道，因為它們需要透過 PMA 流程獲得監管部門的批准。所以——但該團隊確實有一些非常好的產品正在排隊。我確實相信，未來幾年我們將恢復更接近的市場成長，略高於市場成長。但隨著市場持續發展，缺血性方面的競爭顯然變得更加激烈，而我們在出血性方面的業務仍然非常強勁。我們去年推出了幾種產品，Vecta 46 導管、Tetra 彈簧圈，正如您在今年下半年看到的那樣，這些產品推動了美國的一些非常好的成長。

So we like the business. Yes, it's not as fast growing as it was historically, but it's still a very good business. We're committed to it and do expect that, that will pick up as we put VBP in the rearview mirror.

所以我們喜歡這個行業。是的，它的成長速度不像歷史上那麼快，但它仍然是一項非常好的業務。我們致力於此，並期望當我們將 VBP 納入後視鏡時，這種情況將會有所改善。

Our next question will come from Danielle Antalffy with UBS.

我們的下一個問題將來自瑞銀集團的 Danielle Antalffy。

I'll echo everyone's congrats on a really strong end to the year and strong start to 2024. Just a quick question on the orthopaedics market in general. One of the things I've been trying to get a handle on is what's really happening in underlying market growth. Obviously, 2023 benefited from some semblance of a backlog work-down. But it seems like yourselves and your competitors -- not that you gave guidance specifically for ortho, but seemed to be signaling higher than sort of normal, call it, pre-COVID market growth.

我將回應大家的祝賀，祝賀您在今年取得了非常強勁的業績，並在 2024 年取得了強勁的開局。我只是簡單地問一個關於骨科市場的總體問題。我一直試圖了解的一件事是潛在市場成長中真正發生的情況。顯然，2023 年的積壓工作似乎有所減少。但看起來你們自己和你們的競爭對手——並不是說你們專門為 Ortho 提供了指導，但似乎發出了高於正常水平的信號，稱之為新冠疫情前的市場增長。

And I'm curious, beyond pricing, what's really changed here? Has capacity increased? We talked about ASCs. What's changed fundamentally in the orthopaedic -- large-joint orthopaedics market that might be driving higher -- sustainably higher growth versus pre-COVID levels?

我很好奇，除了定價之外，這裡真正發生了什麼變化？容量有增加嗎？我們討論了 ASC。與新冠疫情之前的水平相比，骨科——大關節骨科市場發生了根本性的變化，可能會推動更高的、可持續的更高成長？

Danielle, it's Jason. I think a couple of things, right? And Kevin even alluded to this, I think, earlier as well. But I think there's a variety of things around demographics. Kevin touched on activity levels. Certainly, that plays a part here. We talked about a more favorable pricing environment. Certainly, it plays a role. And then if you think just from an adoption standpoint with robotic-assisted surgery, I think there's a variety of dynamics at play here that have come into play in terms of elevated market levels. And if you saw what we published coming out of Investor Day, we've said over the next 2 to 3 years, we expect this to be in kind of that mid-single-digit range. So we're certainly confident in 2024 and beyond as we think about the ortho markets.

丹妮爾，是傑森。我想有幾件事，對嗎？我認為凱文甚至早些時候也提到過這一點。但我認為人口統計數據涉及多種因素。凱文談到了活動水平。當然，這在這裡發揮了作用。我們討論了更有利的定價環境。當然，它發揮作用。然後，如果您僅從機器人輔助手術的採用角度來看，我認為這裡有多種動態在發揮作用，這些動態在提高市場水平方面發揮了作用。如果你看到我們在投資者日發布的內容，我們已經說過，在未來 2 到 3 年裡，我們預計這個數字將在中個位數範圍內。因此，當我們考慮骨科市場時，我們對 2024 年及以後充滿信心。

And I guess just a follow-up on that. How much of that is Stryker-specific though? Because given the innovation on Stryker's side, the success of Mako and pull-through there, how much is market broadly versus Stryker-specific, if you can even remotely quantify that?

我想這只是後續行動。其中有多少是 Stryker 特有的？因為考慮到 Stryker 方面的創新、Mako 的成功以及那裡的突破，如果您甚至可以遠端量化的話，那麼整體市場與 Stryker 特定市場相比有多大？

Danielle, look, we've always talked about outgrowing the market. Let's call it, round numbers, 300 basis points ahead of the market. And in the past, there was a time when hips weren't quite growing that fast until we launched [it]. But if you go back over the last decade, we have been growing roughly 300 basis points faster than market. So if the market moves up, then our numbers move up as well. And I think you've seen that all year this year, as you've seen in the last couple of years. So that's kind of the way I'd look at it is whatever the market grows, we should be roughly 300 basis points faster because we have this huge lead in robotic-assisted surgery as well as cementless. And we just have a team that's firing on all cylinders.

丹妮爾，聽著，我們一直在談論超越市場的成長。我們稱之為整數，領先市場 300 個基點。在過去，有一段時間臀部的生長速度沒有那麼快，直到我們推出[它]。但如果回顧過去十年，我們的成長速度比市場快約 300 個基點。因此，如果市場上漲，那麼我們的數字也會上漲。我想你今年一整年都看到了這一點，就像你在過去幾年看到的那樣。所以我的看法是，無論市場成長如何，我們的速度都應該快大約 300 個基點，因為我們在機器人輔助手術和非骨水泥手術方面擁有巨大的領先優勢。我們只有一支全力以赴的團隊。

Our next question will come from Matt Miksic with Barclays.

我們的下一個問題將來自巴克萊銀行的馬特·米克西奇。

So maybe a couple of follow-ups on some of the things that have come up, and I'd love to try to get some additional color on M&A. You talked about sort of being back on offense, which is awesome. And just maybe if you could talk a little bit about what that means, large versus small, sort of new platform versus maybe something that strengthens one of your existing businesses like, I don't know, Neurotech or ENT or Neuromod has come up in the past. Anything to add, you can talk about that. That would be great. And then I have one follow-up.

因此，也許對已經出現的一些事情進行一些後續行動，我很想嘗試在併購方面獲得一些額外的色彩。你談到了要重新進攻，這太棒了。也許你能談談這意味著什麼，大與小，某種新平台與可能加強你現有業務之一的東西，比如，我不知道，Neurotech或ENT或Neuromod已經出現在過去。有什麼補充的，大家可以討論。那太好了。然後我有一個後續行動。

Matt, look, I can't get too specific. You know the nature of M&A. M&A is fluid, and the deals have to make sense financially after the buyer that's ready to sell when you want to acquire. I think because of the pent-up demand in the businesses, we have a lot of mouths to feed and they're hungry. And so I would think in the, let's say, at least the first half of the year, there'll probably be more of tucking things in that -- because we've been staying close to these companies, and we have a bunch of deals that are teed up. But then once you get through the first half of the year, I think it becomes open field. And then open field means maybe more tuck-ins, but it means maybe more things that are in the adjacency categories. We're always open to those. But a lot of things have to -- stars have to align in order to be able to do those deals.

馬特，聽著，我不能說得太具體。您了解併購的本質。併購是流動的，當您想要收購時，買家準備出售後，交易必須在財務上有意義。我認為，由於企業的需求被壓抑，我們有很多人需要養活，但他們卻很飢餓。所以我認為，至少在今年上半年，可能會有更多的事情發生——因為我們一直與這些公司保持密切聯繫，而且我們有很多正在準備的交易。但一旦你度過了上半年，我認為它就會變得開放。然後，開放場地可能意味著更多的折疊，但這也意味著可能有更多屬於鄰接類別的東西。我們始終對這些持開放態度。但很多事情都必須——明星必須齊心協力才能完成這些交易。

But we're back on the normal Stryker offense. And again, what does that mean? It means most of the deals, by number, are going to be those tuck-in deals. But things like a Vocera and Neurovascular and those types that do Physio-Control, those kinds of deals are going to pop up that are more in the adjacent categories. But I can't predict this, honestly, because I don't know what's going to happen. But we are out hunting, and we are excited to get back to a more regular M&A. It's been a huge part of our offense. We know how to do this. We've gotten really good acumen around valuations and around integrations, which -- early in my tenure, we weren't so good at integrations. And if I look at Wright Medical, it was just like -- it's just been a role model for how to integrate a complex business, and the results have been stunning.

但我們又回到了正常的史賽克進攻。再說一遍，這是什麼意思？這意味著從數量上看，大多數交易將是那些隱藏交易。但像 Vocera 和 Neuroangio 以及那些進行 Physio-Control 的類型的產品將會出現，這些交易將更多地出現在相鄰類別中。但老實說，我無法預測這一點，因為我不知道會發生什麼事。但我們正在外出尋找，我們很高興能夠恢復更常規的併購。這是我們進攻的重要組成部分。我們知道如何做到這一點。我們在估值和整合方面擁有非常敏銳的洞察力，但在我任職初期，我們並不擅長整合。如果我看看萊特醫療公司，它就像——它只是一個如何整合複雜業務的榜樣，而且結果令人震驚。

That's great. And then just a follow-up on ASCs. This has always been kind of sort of a hot topic, I guess, for the last few years, particularly coming out of the pandemic. So just maybe some thoughts, if you could, on where you are in terms of the build-out of that opportunity? Maybe where -- like the percentage of hips and knees that are now, you think, being done through that channel? And then sort of back to the M&A side of it, is there -- are there other businesses that have some synergy there? You've obviously got [all the] equipment with Mako, with your OR equipment and implant pull-through for these -- to these ASCs. But anything else makes sense to kind of bridge and lever that success you've had there?

那太棒了。然後是 ASC 的後續行動。我想，在過去的幾年裡，這一直是個熱門話題，尤其是在疫情結束後。那麼，如果可以的話，也許可以談談您在建立該機會方面的進展？也許在哪裡——你認為現在通過該通道完成的臀部和膝蓋的百分比？然後回到併購方面，是否有其他業務具有一定的綜效？顯然，您已經擁有 Mako 的[所有]設備，以及用於這些 ASC 的手術室設備和植入物牽引裝置。但還有什麼其他方法可以為您所取得的成功搭建橋樑和槓桿呢？

Okay. I could spend a long time on this, but I'll just sort of cut to the chase and say that, look, things are continuing to progress in the ASC. We're now running between 12% to 15% of our hips and knees in the ASC. That's higher certainly than it was last year. So it continues to climb at a gradual rate because the great limiting factor is capacity and the build-outs of these ASCs. But it is definitely continuing a steady climb. We have everything we need for orthopaedic ASCs. And when I say everything, I mean booms, lights, power tools, Steri-Shield, Neptune, waste management, operating table, every implant from foot and ankle to shoulder to hips to knees to spine. And I'm going to include spine in that because we just most recently did a really terrific ASC deal in spine, a lot of spine procedures moving to the ASC. We did this in Duluth, Minnesota, which is a really exciting deal, and we were able to leverage spine in addition to a lot of other capital equipment in the ASC.

好的。我可以在這上面花很長時間，但我只想切入正題，說，看，ASC 的事情正在繼續取得進展。現在，我們的臀部和膝蓋的 12% 到 15% 都在 ASC 中運行。這肯定比去年高。因此，它繼續以漸進的速度攀升，因為最大的限制因素是這些 ASC 的容量和擴展。但它肯定會繼續穩定地攀升。我們擁有骨科 ASC 所需的一切。當我說一切時，我指的是吊桿、燈、電動工具、Steri-Shield、Neptune、廢物管理、手術台、從腳、腳踝到肩膀、臀部、膝蓋到脊椎的每一個植入物。我將把脊椎也包括在內，因為我們最近剛在脊椎方面做了一項非常棒的 ASC 交易，很多脊椎手術都轉移到了 ASC。我們在明尼蘇達州德盧斯進行了這項工作，這是一項非常令人興奮的交易，除了 ASC 中的許多其他資本設備外，我們還能夠利用脊椎。

And some of those new builds and big renovations, we are absolutely beautifully positioned. What we're now looking at, now that we're a little bit in the GI space with Neptune and the POM acquisition that we have, is what else can we do in that space and other things we could add in that space. Now it's not -- I'm not saying that specifically about ASC. It's about we are -- we like to be really busy in the call point. And now that we're in the GI call point, with every call point we go into, we say, what else can we bring to that call point? What other value can we bring? I'm not predicting that we'll do something in that space, but that's kind of how we look at it. But as it relates to these orthopaedic ASCs, we are in an incredibly good position to be able to win in the ASC world.

對於其中一些新建建築和大型翻修工程，我們的位置絕對優越。我們現在所關注的是，既然我們已經在 Neptune 的 GI 領域有了一些進展，並且我們已經收購了 POM，那麼我們在該領域還可以做些什麼，以及我們可以在該領域添加其他內容。現在不是——我不是專門針對 ASC 這麼說的。這是關於我們——我們喜歡在呼叫點非常忙碌。現在我們處於 GI 呼叫點，對於我們進入的每個呼叫點，我們都會說，我們還能為該呼叫點帶來什麼？我們還能帶來什麼其他價值？我並不是預測我們會在那個領域做一些事情，但這就是我們的看法。但由於它與這些骨科 ASC 相關，我們處於非常有利的位置，能夠在 ASC 領域獲勝。

Our next question will come from Caitlin Cronin with Canaccord Genuity.

我們的下一個問題將來自 Canaccord Genuity 的 Caitlin Cronin。

Congrats on a great quarter. Just jumping up on Matt's question earlier. Momentum in spine really seems to be strong. Do you have any more clarity on how much you've been able to capitalize on the disruption in the space or expect to kind of capitalize from the disruption?

恭喜您度過了一個出色的季度。只是早些時候回答了馬特的問題。脊椎裡的氣勢似乎真的很強。您是否更清楚地了解您已經能夠在多大程度上利用該領域的顛覆或期望從顛覆中獲利？

Yes. I tell you, listen, our performance thus far has really nothing to do with the disruption of the consolidation. I mean it's just starting. We've just started to hear some disruption in Texas as an example and a couple other little spots. So I would say, very early days of disruption, and that's not the reason why we're doing better. We kind of really improved our offense in spine, especially as it relates to enabling tech. I think the Q Guidance was big shot in the arm for the Spine business. They've done a terrific job selling that and then, of course, leveraging that for implants. That's been more of a factor than disruption. I think we're going to see the disruption starting this year. And hopefully, we'll be able to pick up on that. But thus far, there really hasn't been much in the way of disruption. And we're going to see that play out over the course of this year.

是的。我告訴你，聽著，我們迄今為止的表現實際上與整合的破壞無關。我的意思是一切才剛開始。我們剛開始聽到德克薩斯州和其他一些小地方的一些幹擾事件。所以我想說，顛覆的早期階段，這不是我們做得更好的原因。我們確實改善了脊椎進攻，特別是在技術方面。我認為 Q Guidance 對 Spine 業務來說是一劑強心劑。他們在銷售方面做得非常出色，當然，他們也利用它來進行植入。這比干擾更重要。我認為我們將從今年開始看到這種混亂。希望我們能夠抓住這一點。但到目前為止，還沒有出現太大的干擾。我們將在今年看到這種情況的發生。

Got it. And then just a quick one on Mako shoulder. You noted great feedback from docs. What's kind of going to be the use case for the docs? Is it going to be outcomes, time savings, et cetera?

知道了。然後快速地一擊打在 Mako 的肩膀上。您注意到文件提供了很好的回饋。文件的用例是什麼樣的？會帶來成果、節省時間等等嗎？

Just -- look, there's a whole series of outcomes. Just to simplify it, it makes a very hard procedure very easy to do. That's the way I would simplify it. Why was the partial knee so widely successful? It was a hard procedure to do, and the robot made it easy. And the shoulder is harder to do than a partial knee, and it's going to make a very hard procedure very easy to do. It takes stress off the surgeon and have very predictable results. That's been the value prop. There are surgeons I talk to now that, due to high volume of knees, that tell me at the end of the day, I'm not tired anymore. This robot is taking away my stress. It's just making life easier for me, and you can multiply that by 10 for shoulder replacements.

只是——看，有一系列的結果。只是為了簡化它，它使一個非常困難的過程變得非常容易完成。這就是我簡化它的方式。為什麼部分膝關節手術能取得如此廣泛的成功？這是一個很難完成的過程，而機器人讓這一切變得簡單。肩膀比部分膝蓋更難做，這將使非常困難的手術變得容易做。它減輕了外科醫生的壓力並產生非常可預測的結果。這就是價值支柱。我現在和一些外科醫生交談過，由於膝蓋的體積很大，他們在一天結束時告訴我，我不再累了。這個機器人正在消除我的壓力。這只是讓我的生活變得更輕鬆，你可以將其乘以 10 進行肩部置換手術。

Our next question will come from Steven Lichtman with Oppenheimer.

我們的下一個問題將來自史蒂文·利奇曼和奧本海默。

First on price, how are you thinking about the relative pricing outlook in '24 as you look at the major segments of MedSurg Neuro versus Ortho Spine? Anything meaningfully different than what we saw in '23 directionally? And I know we touched on this at Investor Day, but what gives you the confidence in the sustainability of this firmer pricing environment? And then I have a quick follow-up.

首先在價格方面，當您考慮 MedSurg Neuro 與 Ortho Spine 的主要細分市場時，您如何看待 24 年的相對定價前景？與我們在 23 年看到的方向相比，有什麼有意義的不同嗎？我知道我們在投資者日談到了這一點，但是是什麼讓您對這個更堅挺的定價環境的可持續性充滿信心？然後我會進行快速跟進。

It's Glenn. So as we look at price, first of all, we've really honed in a strategy and a group that solely focuses on pricing for the whole company. If we think about sort of those segments, I don't think you'll see a lot of different performance in what we see out of our segments in general. MedSurg and Neurotech has more of an ability to gain pricing, and we see price increases in those businesses. And honestly, even before the pandemic, we would see price increases coming out of the MedSurg businesses.

是格倫。因此，當我們考慮價格時，首先，我們確實磨練了一個策略和一個只專注於整個公司定價的團隊。如果我們考慮這些細分市場，我認為您不會看到我們在一般細分市場中看到的許多不同的表現。 MedSurg 和 Neurotech 更有能力獲得定價，我們看到這些業務的價格上漲。老實說，即使在大流行之前，我們也會看到 MedSurg 業務的價格上漲。

I would say on the Ortho side, the trend has really been that it's just been less negative. Also, if you think about those ortho contracts, they're generally 3-year contracts. So we haven't really even cycled through all those contracts yet. We have real discussions around inflation in our business with our customers. They know it, they experience it themselves. And so we're just -- I'm not expecting to see positives come out of the Ortho side, but we'll probably continue to see less negative.

我想說的是，在 Ortho 方面，趨勢確實是它的負面影響有所減弱。另外，如果您考慮這些正向合同，它們通常是 3 年期合約。所以我們還沒有真正循環過所有這些合約。我們與客戶就業務中的通貨膨脹進行了真正的討論。他們知道這一點，他們自己也經歷過。所以我們只是 - 我不希望看到 Ortho 方面出現積極的情況，但我們可能會繼續看到更少的消極情況。

Got it. And then Glenn, just on PILLAR II, is there an impact in '24 that you're offsetting? And how are you thinking about sort of the potential impact in 2025 based on what you know today?

知道了。然後 Glenn，就 PILLAR II 而言，您正在抵消 24 年的影響嗎？根據您今天所了解的情況，您如何看待 2025 年的潛在影響？

Good question. As we think about 2024, there is an impact for us. I think that through our tax planning and other strategies, we feel like we have fully offset that impact, and that's included in our effective tax rate guidance. For 2025, it's just -- it's too early to comment at this point, to be honest. It's something we're just starting to look at, and we'll have more on that probably a year from now.

好問題。當我們展望 2024 年時，我們會受到影響。我認為，透過我們的稅務規劃和其他策略，我們感覺我們已經完全抵消了這種影響，並且這已包含在我們的有效稅率指導中。對於 2025 年，說實話，現在評論還為時過早。我們才剛開始關注這個問題，一年後我們可能會得到更多相關資訊。

Our next question will come from Mike Matson with Needham & Company Inc.

我們的下一個問題將來自 Needham & Company Inc. 的 Mike Matson。

It sounds like you're looking at doing some more M&A here. I was just curious if you could remind us where your leverage ratio is. And if you have a target, just how high you'd be willing to go there?

聽起來您正在考慮在這裡進行更多併購。我只是好奇您能否提醒我們您的槓桿率是多少。如果你有一個目標，你願意達到多高的目標？

We generally try to maintain a leverage ratio of 2.5 to 3. And I think if you do the calc on 2023, where we're sitting at year-end, we're squarely on the lower end of that range. So we do feel like there is some room, if needed, depending on sort of what we see in the acquisition landscape. But I fully expect that sort of given the normal cadence of acquisitions and that product tuck-ins are generally what we sort of normally go after, we likely won't be out borrowing to do those types of acquisitions.

我們通常會嘗試將槓桿率維持在 2.5 比 3 的水平。我認為，如果您對 2023 年（我們正處於年底）進行計算，我們完全處於該範圍的下限。因此，我們確實覺得如果需要的話，還有一些空間，這取決於我們在收購領域看到的情況。但我完全預計，考慮到正常的收購節奏，以及我們通常追求的產品整合，我們可能不會借錢進行這些類型的收購。

Yes. And keep in mind that 3 is not necessarily an upper limit, right? So that's a normal landing zone for us, this 2.5 to 3. For the right deal at the right price, could we go higher than 3? Sure, we would. And we have -- obviously have to commit to paying down the debt. But we don't really look at us as sort of being constrained that way. So for the right asset, if it's going to be value-creating for Stryker, we are not afraid to push beyond the 3. But that's kind of the land we like to live in as a landing zone.

是的。請記住，3 不一定是上限，對吧？所以這對我們來說是一個正常的著陸區域，2.5 到 3。為了以合適的價格進行合適的交易，我們可以選擇高於 3 的價格嗎？當然，我們會的。我們顯然必須承諾償還債務。但我們並不真正認為自己受到了這種限制。因此，對於合適的資產，如果它能為 Stryker 創造價值，我們並不害怕超越 3。但這就是我們喜歡作為著陸區居住的土地。

Yes, I understand. And then just wanted to ask one about Sports Medicine. I didn't really hear much there. Do you feel like that business is kind of where you want it in terms of the product offering and the scale?

是的我明白。然後只是想問一個關於運動醫學的問題。我在那裡並沒有聽到太多。您覺得該業務在產品供應和規模上是否符合您的要求？

I am so glad you asked about sports. It's absolutely a rocket ship of growth for us for the past 5, 6, 7 years. They have a number of shoulder launches coming out this year, I believe, 4 different shoulder launches. They call it internally, the shoulder [speech], which is quite motivating. But we've done a terrific job with hip. We've had a terrific job with knee, but shoulder has been kind of the area that we've needed to have new products.

我很高興你問起體育問題。在過去的 5 年、6 年、7 年裡，這對我們來說絕對是一艘成長的火箭。他們今年推出了許多肩部發射，我相信，有 4 種不同的肩部發射。他們內部稱之為肩膀[演講]，這相當有激勵作用。但我們在臀部方面做得非常出色。我們在膝蓋方面做得很好，但肩膀是我們需要新產品的領域。

But they've been just an amazing business. It was a start-up 12 years ago, and it just become a big, fast-growing business. It's really helped us win ASC deals. Frankly, having a really -- every ASC deal -- orthopaedic ASC deal involves sports. And because we have such a strong portfolio, we are able to win those deals. But historically, we wouldn't have been able to. And it's an incredibly exciting year of new product launches, particularly in shoulder.

但他們一直是一家了不起的企業。 12 年前，它還是一家新創企業，後來才成為一家快速發展的大型企業。這確實幫助我們贏得了 ASC 交易。坦白說，每筆 ASC 交易中骨科 ASC 交易都涉及體育運動。因為我們擁有如此強大的投資組合，所以我們能夠贏得這些交易。但從歷史上看，我們是做不到的。今年是新產品發布令人難以置信的激動人心的一年，尤其是肩部產品。

And I think some of those hopefully might be shown in AAOS. I'll have to get back to you on that. But I'm very bullish. We have a fabulous leader who's been leading the Sports Medicine business since the start-up when we had just a camera and not really much in the way of implants. And we are now formidable in sport medicine. Certainly in the U.S., certainly in Europe, we still have work to do in the emerging markets in Asia Pacific, but really a fabulous business. And it's been part of the growth engine within Endoscopy. And you've seen Endoscopy post pretty impressive results, certainly last year and this year.

我認為其中一些可能會在 AAOS 中展示。我必須就此回覆你。但我非常看好。我們有一位出色的領導者，從公司成立之初起，他就一直領導著運動醫學業務，當時我們只有一台相機，而且沒有太多的植入物。我們現在在運動醫學方面的實力非常強大。當然在美國，當然在歐洲，我們在亞太地區的新興市場仍有工作要做，但這確實是一項非常棒的業務。它已經成為內視鏡領域成長引擎的一部分。您已經看到內視鏡檢查取得了相當令人印象深刻的結果，尤其是去年和今年。

Our next question will come from Drew Ranieri with Morgan Stanley.

我們的下一個問題將來自摩根士丹利的德魯·拉涅利。

I'll put both of mine together. But Kevin, you were so early on in the orthopaedic robotics landscape just with soft tissue robotics. What are your kind of current thoughts on supporting that ecosystem today versus entering soft tissue robotics? Is it something that's concerning you? Or just how are you thinking about that opportunity? And then second, just -- could you talk about the PROstep launch from earlier in the fourth quarter or late third quarter? Just any metrics you can kind of share there on the foot business.

我會把我的兩個放在一起。但凱文，你在骨科機器人領域很早就涉足軟組織機器人領域。與進入軟組織機器人技術相比，您目前對支援該生態系統有何想法？這與你有關嗎？或者您如何看待這個機會？其次，您能談談第四季度早些時候或第三季末推出的 PROstep 嗎？您可以在那裡分享有關足部業務的任何指標。

Yes, sure. So as it relates to soft tissue robotics, listen, it's a very interesting space. As you know, there's a very large and very successful company that kind of dominates the space. We certainly don't have a problem selling endoscopy if you look at our numbers. Certainly, for our 1788 and our cameras, we're doing extremely well. We still have huge room for growth outside of being in soft tissue robotics. It's an area that we're certainly interested in, but very respectful of the large incumbent. And I'm not sure that we'd want to try to take them head on. Just like anybody trying to come and take us head on in our space, wouldn't be so easy.

是的，當然。因此，當它與軟組織機器人相關時，聽著，這是一個非常有趣的領域。如您所知，有一家非常大且非常成功的公司在該領域佔據主導地位。如果你看看我們的數據，我們銷售內視鏡當然不存在問題。當然，對於我們的 1788 和我們的相機來說，我們做得非常好。除了軟組織機器人領域之外，我們仍然有巨大的成長空間。這是我們當然感興趣的領域，但也非常尊重大的現任者。我不確定我們是否願意嘗試與他們正面對抗。就像任何人想要在我們的空間裡與我們正面交鋒一樣，不會那麼容易。

But it is an area that we like. There are loads and loads of companies, start-ups in the space, and we're looking at them. And it's not inconceivable that we would make a move at some point. But again, not expecting to come out and launch something that would go head-to-head with the Goliath and try to take them down. So -- but it is a space we're pursuing. We're interested. We're looking at companies, and it's not impossible that we would make a move at some point in the future. It's just not an easy space. As you know, robots are hard. And we're going to be very thoughtful and very careful. But we don't see this kind of -- at this point anyways, as a major threat to our Endoscopy business at all.

但這是我們喜歡的領域。這個領域有很多公司和新創企業，我們正在關注它們。我們在某個時候採取行動並非不可想像。但同樣，我沒想到會出現並推出一些與歌利亞正面交鋒並試圖擊倒他們的東西。所以——但這是我們正在追求的一個空間。我們有興趣。我們正在尋找公司，我們在未來某個時候採取行動並非不可能。這不是一個容易的空間。如你所知，機器人很難。我們將非常深思熟慮、非常小心。但無論如何，我們目前並不認為這種情況對我們的內視鏡業務構成重大威脅。

Our next question will come from Matt Taylor with Jefferies.

我們的下一個問題將由馬特泰勒和傑弗里斯提出。

I wanted to ask one about the sprint of margins here and ask you, if you do produce some upside on the top line and the margins over the course of this year and next year, how do you think about delivering that to the bottom line versus reinvesting it above that goal to get back to your pre-COVID margins?

我想問一個關於利潤率衝刺的問題，如果你在今年和明年的過程中確實在營收和利潤方面產生了一些上升空間，你如何考慮將其交付給利潤？將其重新投資到高於該目標的水平，以恢復到新冠疫情爆發前的利潤水平？

I mean, first of all, it's heavily dependent on sort of the mix that we get if we over-deliver on sales in terms of how much margin we can get to. I would say that 200 basis points expansion is the absolute goal, and that will be the target. And if we get there a little sooner, so be it. But we won't take our eye off of making sure that we're doing what's right in the business so that we can deliver that 200 basis points.

我的意思是，首先，這在很大程度上取決於如果我們超額交付銷售，我們可以獲得多少利潤，我們會得到什麼樣的組合。我想說，擴張200個基點是絕對目標，而且也會是目標。如果我們能早一點到達那裡，那就這樣吧。但我們不會忽視確保我們正在做正確的業務，以便我們能夠實現 200 個基點。

And that -- I wanted to ask another one on Vocera. You talked a lot about it on this call, and it's obviously doing well. Can you talk a little bit about how that's expanding its tentacles kind of throughout your organization? And anything else we should expect from it in the future as it connects some of the different technologies and provide you some cross-selling opportunities?

我想問 Vocera 上的另一位。你在這次電話會議上談論了很多，而且顯然進展順利。您能談談它是如何在整個組織中擴展其觸角的嗎？當它連接一些不同的技術並為您提供一些交叉銷售機會時，我們未來還應該對它抱有什麼期望？

Yes. Great. Listen, I -- integrations are challenging. In this one, we had some challenges with the cloud. We had to restructure the sales force. We are already seeing terrific integration with both beds and now more recently with our wireless stretcher. We had a list before we bought the company, and we've expanded that list of connecting products. And those products that we're going to connect to the ecosystem are not just Stryker products, so there are third-party companies that are coming to us and asking to be connected to our ecosystem.

是的。偉大的。聽著，我——整合具有挑戰性。在這一項中，我們在雲端方面遇到了一些挑戰。我們必須重組銷售團隊。我們已經看到了與兩張床的完美集成，現在又看到了我們的無線擔架。我們在收購該公司之前就有了一份清單，我們已經擴大了連接產品的清單。我們要連接到生態系統的那些產品不僅僅是史賽克產品，因此還有第三方公司來找我們並要求連接到我們的生態系統。

So we want to be a vital resource within hospitals. We're even looking at emergency departments that don't have really well-automated workflow that actually do the documentation that take cognitive load off of nurses. So the potential every day, it just keeps expanding and expanding, and so it's wildly exciting. And the team now -- the new sales team is really starting to hum. Our order growth is starting to really, really pick up in a big way.

因此，我們希望成為醫院內的重要資源。我們甚至看到急診室沒有真正良好的自動化工作流程，這些工作流程實際上可以減輕護理人員的認知負擔。因此，潛力每天都在不斷擴大，因此非常令人興奮。現在的團隊－新的銷售團隊真的開始活躍起來。我們的訂單成長開始真正、真正大幅回升。

And so we're super excited. We're not ready to talk about which products we'll be integrating. We'd rather do the integration and tell you about it. And we'd like to sort of give you a full year update. So a year from now, expect we'll give you kind of a wholesome update and include more of those products that will be attached to the ecosystem. But we are really, really excited about this acquisition, and it's a platform.

所以我們非常興奮。我們還沒有準備好談論我們將整合哪些產品。我們寧願進行整合並告訴您。我們想為您提供全年最新情況。因此，一年後，預計我們將為您提供全面的更新，並包含更多將附加到生態系統的產品。但我們對這次收購真的非常非常興奮，它是一個平台。

So I'd say after Mako, this is the second platform acquisition that I've done during my tenure. The other deals we've done, none of them have been platforms. And that means it has wild upside potential over time. Now it's not going to happen overnight. It's going to take time. But this is -- for us, it's -- it will be very sticky in hospitals. It will just be a renewal, a recurring revenue. And then as you add more and more to the ecosystem, it becomes something that hospitals can't live without. So that's our dream, and we're pretty optimistic given where we are right now, given the momentum that we have, given the interest that we have, both from parts of Stryker as well as third-party companies wanting to integrate to the system.

所以我想說，繼 Mako 之後，這是我在任期內完成的第二次平台收購。我們做過的其他交易都不是平台。這意味著隨著時間的推移，它具有巨大的上漲潛力。現在這不會在一夜之間發生。這需要時間。但這對我們來說，在醫院裡會非常棘手。這只是一種更新，一種經常性收入。然後，當你在生態系統中添加越來越多的東西時，它就會成為醫院不可或缺的東西。這就是我們的夢想，考慮到我們現在的處境、我們擁有的動力、考慮到我們的興趣（來自 Stryker 部分部門以及希望整合到該系統的第三方公司），我們非常樂觀。

Our final question will come from Richard Newitter with Truist Securities.

我們的最後一個問題將來自 Truist 證券公司的 Richard Newitter。

I'll just ask one here. And by the way, congrats again on a fantastic quarter. Solid end to the year. So just -- clearly, you guys -- since your Analyst Day, in particular, you've been conveying how committed you are to margin expansion. You're kind of putting a stake in the ground, really strong guidance here for '24. I guess I'm just going to ask, how should we think about that margin guidance relative to the potential and willingness to take on margin dilution as you get more aggressive on the M&A front? Should we think of that as something that already had contemplated the potential -- the need to absorb some dilution? Is there -- are you more focused on top line accretion and more sensitive to kind of margin accretion faster than historically? I would just love your thoughts there on how we should think about kind of this margin trajectory and sprinting back to pre-COVID with respect to deals and how that will fit in the P&L.

我就在這裡問一個吧。順便說一句，再次恭喜這個季度的出色表現。紮實地結束這一年。所以，很明顯，你們，自從分析師日以來，你們一直在表達你們對利潤擴張的承諾。你有點像是把木樁放在地上，這對 24 年來說是非常強有力的指導。我想我只是想問，隨著您在併購方面變得更加積極，我們應該如何考慮相對於利潤稀釋的潛力和意願的利潤指導？我們是否應該將其視為已經考慮過潛力的事情——需要吸收一些稀釋？您是否比歷史上更關注營收成長，對利潤成長速度更快更敏感？我很想聽聽您的想法，我們應該如何思考這種利潤軌跡，並在交易方面衝刺到新冠疫情之前，以及如何將其納入損益表。

Thanks, Rich. Thanks for the question. Look, think back to '17, '18, '19. We were expanding margins before some dilution. We have around 80 basis points. And we were not growing at this kind of growth rate, right? We were growing in the 6s and 7s organically, not double-digit growth organically or high single-digit growth organically.

謝謝，里奇。謝謝你的提問。看，回想一下'17，'18，'19。在進行一些稀釋之前，我們正在擴大利潤率。我們有大約 80 個基點。我們並沒有以這種成長率成長，對吧？我們的有機成長是在 6 年代和 7 年代，而不是兩位數的有機成長或高個位數的有機成長。

So with that higher growth, this is not a crazy level of margin expansion that we think we could do. But doing small deals and if they're small tuck-in varieties, there's some dilution that will come with that. We expect we're going to eat that and be able to deliver the 200 basis points. If a deal came along, let's say, something like a Mako, which as you know occurs once a decade maybe, it's not an everyday occurrence, that had dilution but we felt was just so great for the company that we had to do it, we would go ahead and do it. And then we would look at our numbers and say, is this something we can absorb? Or isn't it?

因此，隨著更高的成長，這並不是我們認為可以做到的瘋狂的利潤擴張水平。但如果是小額交易，而且是小品種，就會帶來一定程度的稀釋。我們預計我們將承受這個壓力並且能夠實現 200 個基點。如果達成一項交易，比如說，像Mako 這樣的交易，正如你所知，這種交易可能十年一次，它不是每天都會發生，它會被稀釋，但我們覺得對公司來說太棒了，所以我們必須這樣做，我們會繼續做下去。然後我們會看看我們的數字並說，這是我們可以吸收的東西嗎？或者不是嗎？

Our going-in assumption is that that's not a likely occurrence. It's not impossible though. And I never want to rule anything out when it comes to M&A. If something really delicious appears and we think that this is going to be great for our future, we're going to go ahead and do it. And then we'll do our math and figure out, can we get there with the 200 basis points? But in the normal cadence of operations of Stryker, and that means doing a number of deals that have a little bit of dilution here or there, we're going to eat it and we'll deliver our 200 basis points. If something bigger happens like a Mako that, as you know, was very dilutive but has proven to be a pretty terrific asset for our company, we're not going to say, well, we're going to wait 2 years and then we'll do it later. We're going to go ahead and do it.

我們的初步假設是這種情況不太可能發生。但這並非不可能。在併購方面，我從不想排除任何可能性。如果出現了真正美味的東西，並且我們認為這對我們的未來有好處，我們就會繼續做下去。然後我們會計算一下，我們能用 200 個基點來實現這一目標嗎？但按照史賽克的正常運作節奏，這意味著要做一些有一點稀釋作用的交易，我們將把牠吃掉，我們將提供 200 個基點。如果發生像Mako 這樣更大的事情，正如你所知，它的稀釋性非常大，但已被證明對我們公司來說是一筆非常棒的資產，我們不會說，好吧，我們會等2 年，然後我們稍後會做。我們將繼續做下去。

But again, I don't see that on the horizon. It's not obvious to me. But I'd never want to rule that out. It would be foolish, frankly, to be beholden to a certain financial target and pass up what could be very value creating for our company. But again, it's not our current frame of mind, not our current thought process. But I don't want to rule out that, that could be a possibility.

但同樣，我並沒有看到這種情況的出現。這對我來說並不明顯。但我永遠不想排除這一點。坦白說，只顧某個財務目標而放棄可能為我們公司創造巨大價值的目標是愚蠢的。但同樣，這不是我們目前的心態，也不是我們目前的思考過程。但我不想排除這一點，這可能是一種可能性。

I will now turn the call back over to Mr. Kevin Lobo for closing remarks.

現在我將把電話轉回給凱文·洛博先生做總結發言。

Thank you all for joining our call. As you can see, we have terrific momentum as we finish the year. We're excited about 2024, and we look forward to sharing our first quarter results with you in April. Thank you.

感謝大家加入我們的通話。正如您所看到的，我們在今年結束時勢頭強勁。我們對 2024 年感到興奮，並期待在 4 月與您分享我們的第一季業績。謝謝。