Teleflex - Q1 2023

Transcript

Operator (participant)

Please stand by. Good morning, ladies and gentlemen. Welcome to the Teleflex First Quarter 2023 Earnings Conference Call. At this time, all participants have been placed in a listen-only mode. At the end of the company's prepared remarks, we will conduct a question-and-answer session. Please note that this conference call is being recorded and will be available on the company's website for replay shortly. Now I will turn the call over to Mr. Lawrence Keusch, Vice President of Investor Relations and Strategy Development.

Lawrence Keusch (VP of Investor Relations and Strategy Development)

Good morning, everyone, and welcome to the Teleflex Incorporated First Quarter 2023 Earnings Conference Call. The press release and slides to accompany this call are available on our website at teleflex.com. Please note that webcast viewers have the ability to advance the presentation slides on their own. Simply follow along with the presentation as we proceed through the call. As a reminder, a replay will be available on our website. Those wishing to access the replay can refer to our press release from this morning for details. Participating on today's call are Liam Kelly, Chairman, President, and Chief Executive Officer, and Thomas Powell, Executive Vice President and Chief Financial Officer. Liam and Tom will provide prepared remarks, and then we'll open the call to Q&A.

Before we begin, I'd like to remind you that some of the matters discussed in the conference call will contain forward-looking statements regarding future events as outlined in the slides posted to the investor relations section of the Teleflex website. We wish to caution you that such statements are in fact forward-looking in nature and are subject to risks and uncertainties, and actual events or results may differ materially. The factors that could cause actual results or events to differ materially include, but are not limited to, factors referenced in our press release today, as well as our filings with the SEC, including our Form 10-K, which can be accessed on our website. I will turn the call over to Liam for his remarks.

Liam Kelly (Chairman, President, and CEO)

Thank you, Larry. Good morning, everyone. It is a pleasure to speak with you today. For the first quarter, Teleflex revenues were $710.9 million, a year-over-year increase of 10.8% on a reported basis and an increase of 13.2% on a constant currency basis. First quarter adjusted earnings per share was $3.09, a 7.3% increase year-over-year. We had a strong start to 2023 as momentum exiting last year continued into the first quarter. Even when excluding the impact of five extra shipping days in the first quarter, our underlying growth was robust at 7.1%. As a reminder to investors, a day is typically worth approximately 1% revenue growth in a quarter.

For the first quarter of 2023, each extra day was in actuality slightly in excess of 1% growth. When strung together, the five extra shipping days added approximately 6% to our constant currency growth. In the quarter, both the high growth portfolio, excluding UroLift, and the durable core grew in the low double digits year-over-year, excluding the five extra shipping days in the quarter. Behind an improving procedure environment, we executed well during the quarter with all global product categories driving growth. The balanced performance in the quarter continues to demonstrate the benefit of Teleflex's diversified product portfolio and broad geographic footprint. In the quarter, we saw strong contributions from our interventional, surgical, and OEM product categories. From a geographic perspective, Europe was in line with expectations, while Asia remained a key growth driver.

From a macro perspective, we are seeing a stabilization in inflation and supply chain as expected. Of note, we have seen some easing in supply constraints for Tyvek during the first quarter and continue to expect the situation to further improve in the second half of the year as additional industry capacity comes online. We are also seeing a continued improvement in staffing challenges in the hospital setting. This was evident in our first quarter revenue growth as the majority of Teleflex products are exposed to the hospital setting. Conversely, we are still experiencing geographic pockets that are encountering more persistent staffing disruption in the ASC and office site of service. Let's turn to a deeper dive into our first quarter revenue results. I will begin with a review of our geographic segment revenues for the first quarter.

All growth rates that I refer to are on a constant currency basis, unless otherwise noted. Americas revenues were $411.9 million, which represents 9.2% growth year-over-year. We saw growth across the majority of our businesses, including double-digit increases in interventional and surgical revenues. In addition, the results included the impact of the five extra shipping days. EMEA revenues of $143.3 million increased 10.5% year-over-year. The year-over-year growth includes the benefit of the five extra shipping days in the quarter, while the underlying performance reflects continued improvement in the year-over-year procedure volumes that fueled broad-based revenue growth across our product portfolio. Turning to Asia. Revenues were $78.7 million, increasing 22.8% year-over-year. We saw strength across the region with all geographies posting solid growth during the first quarter.

China remained a solid contributor with very high single-digit growth in the quarter. Although surgical procedure activity in China has not yet returned to normal levels following the termination of the zero-COVID policy in late 2022, we saw improvements as we progressed through the quarter. Looking forward, we would expect growth in China to accelerate during the remainder of 2023. Let's now move to a discussion on our first quarter revenues by global product category. Commentary on global product category growth for the first quarter will also be on a constant currency basis. Starting with vascular access. Revenue increased 9.2% to $177.7 million. The performance was solid across the portfolio and we are now past the tough COVID comparisons experienced during 2022.

As I noted earlier in the call, we saw some improvement in Tyvek supplies in the first quarter and expect further availability in the second half of the year as additional manufacturing capacity for the industry comes online. Of note, our PICC portfolio returned to double-digit growth in the quarter. Over the long term, we remain positioned for dependable growth with category leadership in central venous catheters and midlines, anticipated share gains from our novel coded PICC portfolio and new product introductions. Moving to interventional access. Revenue was $116.9 million, up 23.3% year-over-year. We continued to benefit from our diversified portfolio and saw strength across our largest product categories, including complex catheters, balloon pumps, and OnControl. MANTA continues to penetrate the large-bore closure market globally. Turning to anesthesia.

Revenue was $93.3 million, up 9.9% year-over-year. Of our larger franchises, hemostatic products, regional anesthesia, and endotracheal tubes all had strong performances in the first quarter, partly offset by LMA single-use masks. In our surgical business, revenue was $99 million, up 14.3% year-over-year. Among our largest product categories, metal ligation clips and instrument revenue increased double digits year-over-year. In the quarter, we advanced our integration of Standard Bariatrics and trained new surgeons on the use of the Titan SGS stapler in sleeve gastrectomy procedures. We showcased Titan at the recent The surgeon feedback was overwhelmingly positive. For interventional urology, revenue was $75.4 million, representing an increase of 0.9% year-over-year.

We witnessed growth for UroLift in the hospital setting, the office site of service continues to be impacted by staffing shortages. We continue to expect the U.S. end market for UroLift to continue to improve as we progress through 2023. The overseas launch activity in Japan and China are progressing in line with expectations. OEM revenues increased 34.5% year-over-year to $77 million. The strength in the quarter was broad-based across our portfolio with double-digit growth in all product categories. We continue to have good visibility into the business and see solid demand dynamics throughout 2023. First quarter other revenue increased 6.4% to $71.6 million year-over-year. We continue to expect all MSA revenues to cease at the end of 2023, implying no MSA revenue in 2024.

That completes my comments on the first quarter revenue performance. Turning to some commercial and clinical updates. We continue to execute on our commercial strategy for the Titan SGS powered stapling device for use in sleeve gastrectomy procedures to treat obesity. We recently announced a supply agreement with W. L. Gore & Associates to use the company's GORE SEAMGUARD Bioabsorbable Staple Line reinforcement material in a staple line reinforcement device designed by Teleflex for use with the Titan SGS Stapler. Buttress material is commonly used by surgeons to reduce leaks and bleeding and strengthen the staple line by redistributing the pressure exerted by an individual staple over a wider area, as well as provide reinforcement for friable tissue. The ability to offer synthetic buttressing material alongside the unique features of the Titan stapler should enable Teleflex to further address surgeon clinical needs and preference in the sleeve gastrectomy market.

We anticipate launching the Teleflex applicator with GORE buttress material by year-end 2023. Moving to our hemostatic product portfolio. We have received FDA 510(k) clearance for the QuikClot Control+ for mild to moderate bleeding in cardiac procedures and bone bleeding following sternotomy. This new indication expands upon the prior indication for temporary control of internal organ space bleeding for patients displaying severe bleeding. The expanded indication follows the completion and analysis of an IDE study that examined the rate at which subjects achieved hemostasis through 10 minutes of hemostatic application and compression at the bleeding site. The study concluded that the QuikClot Control+ hemostatic device was superior in achieving clinical hemostasis in cardiac surgery for mild and moderate bleeding.

The expanded indications enable QuikClot Control+ utilization across a wider patient population and breadth of surgical procedures and expand our global market opportunity for our portfolio of hemostatic products. We will begin promoting our new indication in the coming months. Now, moving to an update on the interventional access business. We are excited about our building momentum for 2023 with a focus on complex PCI and structural heart. Of note, we continue to focus on driving our innovation engine and will be launching a number of new products over the coming years. Augmenting our channel presence in complex PCI, we recently commenced a limited market release for the GuideLiner Coast with positive initial feedback from physician users. GuideLiner Coast builds upon our successful GuideLiner extension catheter franchise with the addition of a hydrophilic coating to improve deliverability.

In addition, we will initiate a limited launch for the Triumph microcatheter during the second quarter. The Triumph is a unique catheter design that will be supported by a chronic total occlusion clinical study, which is planned to enroll patients in 2023. We also continue to advance our Wringer perfusion balloon catheter with two clinical studies currently enrolling patients. Separately, we continue to expand our structural heart presence. Our dedicated sales force is currently selling MANTA and the Langston dual lumen catheter. Looking forward, we are actively engaged in expanding our product portfolio with the Watson, representing the next product anticipated to launch. The Watson is a unique dual delivery guide wire and pacing wire for use in TAVR procedures. Lastly, I will provide an update on our vascular access business.

We are excited to announce that we have launched two new devices designed to enhance PIC insertion procedures and reduce the chance of complications. First, we have launched the next generation Arrow VPS Rhythm DLX device, which provides real-time PICC catheter tip location information using a patient's cardiac electrical activity. The device also features an optional integrated ultrasound module to assist with vascular access. Coupled with our TipTracker technology, use of the DLX eliminates the need for confirmatory X-ray, which reduces time to therapy and cost. In addition, we have launched the new Arrow PICC preloaded with the NaviCurve Stylet. The NaviCurve Stylet features an anatomical curve and flexible tip that are designed to self-orientate to patient anatomy for enhanced PICC advancement into the superior vena cava for successful insertion. That completes my prepared remarks.

I would like to turn the call over to Tom for a more detailed review of our first quarter financial results. Tom?

Thomas Powell (EVP and CFO)

Thanks, William. Good morning. Given the previous discussion of the company's revenue performance, I'll begin with margins. For the quarter, adjusted gross margin was 59.4%, a 100 basis point increase versus the prior year period. The year-over-year increase was primarily due to price, lower logistics and distribution-related costs, and favorable fluctuations in foreign currency exchange rates, partially offset by continued cost inflation, including raw materials and labor costs. Of note, we maintained our pricing discipline in the first quarter and continue to expect at least 50 basis points of positive price year-over-year in 2023. Adjusted operating margin was 25.8% in the first quarter. The 10 basis point year-over-year increase was the result of the flow-through of the gross margin, partially offset by headcount and employee-related expenses, investments to grow the business, and the inclusion of Standard Bariatrics.

Net interest expense totaled $17.5 million in the first quarter, an increase from $10.2 million in the prior year period. The year-over-year increase in net interest expense reflects higher interest rates versus the prior year, partially offset by a reduction in average debt outstanding. Our adjusted tax rate for the first quarter of 2023 was 11.8% compared to 11.9% in the prior year period. At the bottom line, first quarter adjusted earnings per share was $3.09, an increase of 7.3% versus prior year. Turning now to select balance sheet and cash flow highlights.

Cash flow from operations for the first quarter was $84.3 million compared to $62.1 million in the prior year period. The increase was primarily due to favorable changes in working capital, driven by higher accounts receivable collections, partially offset by an increase in inventories to maintain high customer service levels during a period of elevated global supply chain volatility. Moving to the balance sheet. Our financial position continues to provide us the flexibility to operate the business and execute on our disciplined capital allocation strategy. At the end of the first quarter, our cash balance was $264.1 million as compared to $292 million as of year-end 2022. The reduction in cash on hand is primarily due to $75 million of payments on our senior credit facility.

Net leverage at quarter end was approximately 1.7x, which remains well below our 4.5x covenant. Turning now to financial guidance. We are very pleased with our first quarter financial performance. Of note, we have seen a recovery in surgical procedures, most notably those that are performed in the hospital. Staffing shortages continue to improve in the hospital. Inflation and supply chain headwinds have stabilized. Given the solid start to the year, we are updating our 2023 financial guidance. Specifically, we are raising the low end of our 2023 constant currency revenue and now expect growth of 5% to 6.25%. Turning to foreign exchange. We now assume a foreign exchange translation headwind of approximately 35 basis points in 2023.

Our prior guidance of a 50 basis point headwind for 2023 assumed a $14 million negative impact of foreign exchange for the full year, of which $17 million was expected in the first quarter. The actual first quarter headwind was approximately $4 million less than was expected. Our revised foreign exchange guidance for 2023 captures the actual rates for the first quarter, while the foreign exchange assumptions set at the beginning of 2023 remain unchanged for the balance of the year. Considering the revised foreign exchange headwind, we expect reported revenue growth of 4.65% to 5.9% in 2023, implying a dollar range of $2.921 billion-$2.956 billion.

We are reiterating our 2023 guidance for adjusted earnings per share of $13.00-$13.60. We are lowering our GAAP adjusted earnings per share outlook to $8.14-$8.74, primarily due to a one-time tax item. All other elements of our adjusted financial guidance for 2023 remain unchanged, including our outlook for adjusted gross and operating margins. That concludes my prepared remarks. I would now like to turn it back to Liam for closing commentary.

Liam Kelly (Chairman, President, and CEO)

Thanks, Tom. In closing, I will highlight our three key takeaways from the first quarter of 2023. First, we started 2023 with a strong performance as momentum continued from the end of last year. We executed well across our global business and continued to effectively manage the macro headwind. Second, the solid first quarter performance keeps us well positioned to deliver on our financial guidance for 2023. We see an increasingly stable environment for healthcare utilization. In turn, we expect improving performance of our high-growth portfolio as we move through 2023, in addition to continued strength in our durable core. Third, importantly, we will continue to focus on our strategy to drive durable growth. We will invest in organic growth opportunities and drive innovation, expand our margins and execute on our disciplined capital allocation strategy to enhance long-term value creation. That concludes my prepared remarks.

Now I would like to turn the call back to the operator for Q&A.

Operator (participant)

Thank you. If you'd like to ask a question, please press star one on your telephone keypad. If you are using a speakerphone, please make sure your mute function is turned off to allow your signal to reach our equipment. We do ask that you limit yourself to one question and one follow-up. If you would like to ask additional questions, we invite you to add yourself to the queue again by pressing star one. Our first question today comes from Cecilia Furlong from Morgan Stanley. Cecilia, your line is open. Please go ahead.

Cecilia Furlong (VP of Equity Research)

Great. Good morning, and thank you for taking the questions. Liam, I wanted to start just some of your comments on what you're seeing from a recovery standpoint, hospital versus ASC and in office-based setting. Specific to your list, can you just speak to what you've seen, where you are from a recovery standpoint in the hospital setting versus, ASC office-based? As you look through the balance of the year too, relative to that 8%-9% longer-term CAGR for the business, how do you look at, where you are today and tracking relative to that growth rate?

Liam Kelly (Chairman, President, and CEO)

Thanks for the question, Cecilia. I will start at the macro level for overall procedures. Obviously, delivering 13.2% growth in Q1 was ahead of our expectation. Ex the days that came in over 7%, we're really pleased with the first quarter, when our guide at the midpoint was approximately 6%. Overall procedure volume within the hospital has continued to move forward and to progress. We're seeing that in particular in the Americas and in EMEA. What we see overseas in APAC is a strong environment, and we see, especially as you got through March, we saw China start to pick up. For UroLift specifically, we saw growth again in the hospital side of service, which is encouraging.

This is now a sequential quarters of growth in the hospital side of service. In the office side of service, it did show some modest improvement, but it is still challenging due to staffing issues and obviously due to patient flow. Just investors familiar with Teleflex will realize that the patient flow dynamic really started to have an impact as you went into the latter half of the year. It began as you went through Q2 into Q3. We would still anticipate an improving environment for UroLift as we go through the year. Within the quarter, UroLift came in as expected in the first quarter of this year, and we feel that we're building good momentum. We had a really strong presence at AUA, and we're encouraged by the enthusiasm we see from urologists.

Operator (participant)

The next question comes from Shagun Singh from RBC. Shagun, your line is open. Please go ahead.

Shagun Singh (Senior Equity Research Analyst)

Great. Thank you so much for taking the question. Your 2023 revenue guidance, it implies a step down in growth for the balance of the year. What is driving that outlook? Is it conservatism, or is there anything else to call out? How should we think about the cadence for the balance of the year? Also, as we look at EPS, you've held EPS despite the Q1 beat. I'm just wondering if there are any P&L offsets to consider, due to which you didn't narrow the EPS range.

Liam Kelly (Chairman, President, and CEO)

Okay, I'll ask Tom to comment on the EPS in a moment. I'll answer your question regarding the revenue. Shagun, we were very clear in the first quarter that our plan is front-end loaded. If I'm an investor, I would want to have a front-end loaded plan from a company rather than a back-end loaded plan for a company. There are a few dynamics that play into that in certain parts of our businesses. Obviously, as we go through the year, we have some tougher comparables as you get into the back half of the year. Obviously, there's the days impact. You've got 5 additional days in the first quarter. You got five less days in quarter four. We feel really good about the full year.

Starting off strong gives us increased confidence in our ability to deliver on our guidance as we go through the year. Also, you know, it's one quarter. It's the first quarter of the year. It's great to have a good solid start. We'd like to get another couple of quarters tucked under our belt, and then we'll see where we land. We do feel that there is a increased momentum behind Teleflex and our momentum within the marketplace just based on the procedural dynamic, based on some of our key business units and regions performing exceptionally well. Businesses like OEM, Interventional Access had really strong marches at the month of March. It's really good to see Vascular get back to growth as expected. We told investors that Vascular would get back to growth.

It's great to see it getting back to growth. The high-growth portfolio had a really solid first quarter, and Durable Core, as expected, outperformed in the first quarter just due to that whole procedural volume. I'll ask Tom to discuss pre-briefly the other part of your question around EPS.

Thomas Powell (EVP and CFO)

Okay, just as it relates to EPS. Keep in mind that first of all, we didn't provide quarterly EPS guidance for the first quarter. In the quarter, our EPS results came in very much in line with our internal expectations. You know, we remain very confident in the full-year EPS guidance outlook and are very pleased with how the first quarter turned out. I would say that, you know, as Liam mentioned, stay tuned, and we'll continue to monitor the situation, but feel very, very good about how the quarter played out.

Operator (participant)

The next question comes from Kris Campbell from Jefferies.Kris, your line is open. Please go ahead.

Kris Campbell (Equity Research Associate of Medical Supplies and Devices)

Hey, how you doing? This is Kris on for Matthew Taylor. You touched a little bit on UroLift growth. I was wondering if you could dig a little bit deeper on the high-growth portfolio and some of the trends you're seeing there, including the Standard Bariatrics acquisition?

Liam Kelly (Chairman, President, and CEO)

Yeah, absolutely, Kris, thanks for the question. I will tell you that Titan had a really strong start to the year. We still expect it to do $30 million-$35 million. MANTA came in online, is on track for the full year. Hemostat did really well in the first quarter, came out of the blocks fast. Intraosseous did inline and PICC. Great to see PICC come back to growth. As we told investors, once the Tyvek situation started to get better, we would expect PICC to return to growth. That's exactly what happened within the quarter. PICC came back with a very solid performance, and we would expect that to continue as we go through the year.

I would anticipate many of the parts of the, of the high growth portfolio to continue to accelerate as we go through the year. That would speak to UroLift, MANTA, Titan, the PICCs, and also some of the Intraosseous portfolio. That would be our expectation, and that's what's contemplated within our guide.

Kris Campbell (Equity Research Associate of Medical Supplies and Devices)

Awesome. Appreciate it. Thanks for taking the question.

Operator (participant)

The next question comes from Mike Matson from Needham & Company. Mike, your line is open. Please go ahead.

Mike Matson (Managing Director and Senior Equity Research Analyst)

Yeah, good morning. Thanks for taking my questions. I want to ask one on UroLift. You know, just did you see the same degree of selling the day impact there that you saw on the rest of the business? Because if you did, that would sort of imply a fairly, you know, decent decline again there, kind of mid-single digits, I think. Or is there some reason that didn't benefit UroLift?

Liam Kelly (Chairman, President, and CEO)

Mike, the day's impact for UroLift is similar to the rest of the business, so that would, you're absolutely correct, that would show some modest decline. Mike, that's what we were expecting in the first quarter, and it came in exactly as we would've anticipated. We did get some analysis on the day's impact. Pardon me, on the patient flow impact, and we have it through January and February. Through the first two months of the quarter, patient flow declined by another 3.7%. As we go through the year, Mike, what we will anticipate seeing is getting over the tough comparable on patient flow.

As I said a little earlier, the patient flow dynamic really started to get notably worse in 2022 as you went through the year beginning in Q2 and Q3, where we had double-digit declines in patient flow. Once we get through that comparable, we would anticipate as we go through the year an improving environment for UroLift.

Mike Matson (Managing Director and Senior Equity Research Analyst)

Okay, understand. Just the MSA headwind, can you just quantify that for us again, just as a reminder, so we can make sure we incorporate that correctly into our models?

Liam Kelly (Chairman, President, and CEO)

Yeah. The MSA headwind as you go from 2023 into 2024 is approximately $70 million, Mike. But that's low margin revenue going away. You lose the $70 million in revenue, but as you go down through the income statement, you will pick up approximately 100 basis points on gross margin as a result of that MSA going away. Of course, that was the whole idea of Teleflex pruning in order to grow. The respiratory assets were lower growth assets. They were lower margin assets.

Now the investors will see the benefit of that in 2024 as that complete low growth area has gone out of our portfolio, the MSA has gone out of our portfolio, and you'll see an impact on gross margins and a chunk of that dropping through to op margins in 2024 as well.

Operator (participant)

The next question comes from Jayson Bedford from Raymond James. Jason, your line is open. Please go ahead.

Jayson Bedford (Managing Director and Senior Analyst of Medical Technology)

Good morning. Just a couple questions here. OEM and interventional were quite strong with outsized growth. I just wanna make sure there's no kind of one-timers in there. Just secondly on OEM, you know, you mentioned pretty good visibility through 2023. What kind of growth are you looking at from this segment? Thanks.

Liam Kelly (Chairman, President, and CEO)

Our OEM business had a stellar start, you know, 34.5%. Obviously, you gotta take the day's impact out of that. It was across the board. We were really strong on catheters. We were really strong on extrusion. Sutures performed very well. The acquisition we did a couple of years ago, HPC, continues to perform exceptionally well and allow us to sell some of our products through to other customers. We would still expect the OEM business to be a high single-, low double-digit grower, probably now leaning more to the low double digits given this really strong start to the year. They had a really nice March performance, came in a little bit better than we were expecting.

They did have a prior year easier comp in Q1, which helped them. The momentum that they carried in from Q4 continued into Q1 and is performing exceptionally well. Candidly, OEM has been performing exceptionally well for the last three years now. This isn't just a one-quarter phenomenon, even though it's a little bit better this quarter. Within interventional access, you know, again, a very strong performance, over 23% growth. The return of Langston really helped. Complex catheters, the GuideLiner, TrapLiner, Turnpike performed well. A lot of procedural volume bringing us through there. As we go through the year, you know, in Q3, they'll comp the Langston return to the market.

Notwithstanding that, this is going to be a nice, solid growth driver with really good margins. As we went through in our prepared remarks, a really nice setup with new products coming through with the GuideLiner Coast, with the Wattsan, with the Wringer, and with the Triumph that now coming to market. The lifeblood of this business in the past has been new products. Some of the changes we made in our R&D processes have really started now beginning to show bear fruit, as you heard during my prepared comments. OEM and IA, you're right, Jayson, are the ones that kind of really drove the upside from the expected 6%-7% within Q1.

Kris Campbell (Equity Research Associate of Medical Supplies and Devices)

The visibility on OEM.

Liam Kelly (Chairman, President, and CEO)

Visibility on OEM is excellent. Sorry. Thanks, Larry. Visibility on OEM, it's one of the businesses where we have the longest visibility. I see a very stable environment for that business over the next period of time.

Operator (participant)

Next question comes from Anthony Petrone from Mizuho. Anthony, your line is open. Please go ahead.

Anthony Petrone (Managing Director of Equity Research)

Thanks. Good morning, everyone. Maybe Liam or Tom, just high-level comments on procedure volume. Certainly, we saw it in vascular interventional. A lot of data points in the quarter that we've certainly, you know, gotten to a new level for procedure volumes. In particular, not necessarily that staffing issues have improved to normal, but that workflow at hospitals has improved. Maybe just a little bit on the sustainability of procedure volumes broadly as it, you know, relates to the other businesses in the hospital, not specifically outpatient, and then I'll have a follow-up as well. Thanks.

Liam Kelly (Chairman, President, and CEO)

Yeah, Anthony. I mean, obviously, within the quarter growing 7%, coming off a Q4 at 4.3% and a full year last year adjusted at 4.3%, you can see the progress. I mean, it's more than just procedural volumes. A lot of the new products that we're talking about are building momentum within the business. obviously having Standard Bariatrics and the Titan product is helping us. I've been saying this for many quarters now, if you're in the hospital, over the last period of time, and I think it's going to be sustainable for sure over a number of quarters, procedural volume is really strong. There's a lot of impetus to get procedures done. We're seeing it broadly within EMEA and within the Americas.

As I said a little earlier, with China coming back on stream, we would anticipate getting additional growth out of procedure volume coming through from that lockdown practice, within APAC and specifically within China. Regarding staffing, it's not back to where it was, it would be my observation, but it is getting better and better and better every quarter. I think to your comment about the other sites of service, once it gets better in the hospital, we will see that, go through to the ASC and the office, in the near term. I think it's very encouraging what we're seeing in the, in the hospital side of service.

I see it as pretty sustainable over a multi-quarter period, Anthony, but I wouldn't want you to go away thinking it's just procedural volume. There are some things that we're doing uniquely within Teleflex that's driving a lot of our momentum as well.

Anthony Petrone (Managing Director of Equity Research)

That's great. The follow-up would be maybe just your views here most recently on the M&A environment. We're seeing transactions come through within the space. You know, maybe just updated thoughts on valuations just also, you know, the cost of funding. I mean, how does that change the equation now just where the debt markets are when Teleflex thinks about M&A? Thanks.

Liam Kelly (Chairman, President, and CEO)

Yeah, Anthony. We're very active within the market. Our leverage is now 1.7x. We have the most important thing you need when you're doing M&A, we have firepower. Right now we would have the potential, not saying we're gonna do this, but we would have the potential to put up to about $2 billion worth of capital to work. We are really active in all areas of M&A, really happy with Standard Bariatrics having brought that in. I think that we are looking at tokens, we're looking at scale, we're looking at late-stage technologies across the board. I'll talk a little bit about the cost of funds, but maybe I'll ask Tom to add a comment as well.

I think what we're seeing is the cost of funds is improving somewhat. The environment we think is a little bit better than it was even a number of months ago. And with regard to valuations, I think valuations are where they were over the last number of quarters. They've come back from the heady days halfway through 2021, and I think it's an environment that's very attractive to Teleflex. Anthony, we will continue to be disciplined. Investors should know that when we do announce a deal and we bring something into Teleflex, we've done our appropriate work, and it's the right deal for Teleflex. Anthony, you want to add on the cost of funds, Tom?

Thomas Powell (EVP and CFO)

Well, I was just gonna say that, yes, while, certainly the cost of funds are up from where they were two years ago or one year ago, you know, they're still at fairly reasonable levels overall, you know, based on where we're currently looking at as a cost of funds relative to where it's been over the past 10 or 20 years. I don't believe right now that that will be an inhibitor to our ability to identify, you know, assets. Right now our focus is, really is Liam put on finding the right strategic fit, that makes sense for us, and the cost of funds will certainly be a component, but not a limiting component.

Operator (participant)

The next question comes from Craig Bijou from Bank of America. Craig, your line is open. Please go ahead.

Craig Bijou (Equity Research Analyst of Medical Devices and Supplies)

Good morning, guys. Thanks, thanks for taking the question. Wanted to touch on margins. Obviously you raised revenue guidance, but the margin guidance didn't change. Wanted to see if you could walk through the cadence of gross margin and operating margin throughout the year. Then given the Q1 performance in both gross margin and operating margin seemed to be better than the prior year, which is trending ahead of your overall guidance for 2023. Why couldn't we potentially see upside to your margin guidance? You know, what are some of the things that we should be considering with margins for the rest of the year?

Liam Kelly (Chairman, President, and CEO)

Yeah, Craig. Thanks for the question. I think, you know, one thing I would just like to point out is it's May. It's very early in the year. We're really happy with the start that we had to the year, both on revenue, on margins, and on earnings. My mother, God rest her, used to say, "A good start is half the battle," and we've had a good start. I'll let Tom give you a little bit more details on some of the margin impacts, if you don't mind, Tom.

Thomas Powell (EVP and CFO)

Sure. On the gross margin front, you know, you should expect to see a pretty stable gross margin throughout the remainder of the year. It'll move up and down, but not significantly from where it is right now. On the op margin, what you should expect to see is a sequentially improving operating margin as we go throughout the year. A couple of things you probably wanna keep in mind is that as you look at the kinda comparison to prior year or, for the gross margin, we had a more favorable comp in the first quarter than we're gonna have for the balance of the year. When looking at year-over-year comparisons, that certainly comes into play. We also are expecting foreign exchange headwinds on gross margin as we go throughout.

Liam Kelly (Chairman, President, and CEO)

Year. In the first quarter, we actually had a nice benefit. If you recall last year, the dollar moved significantly beginning in second and third quarters, and as a result, you know, that's gonna prove to have a more difficult comparison. Those are some of the factors I think about, but again, you know, gross margin is pretty stable throughout the year, and operating margin will show sequential improvement.

Operator (participant)

The next question comes from George Sousoulas from Stephens. George, your line is open. Please go ahead.

George Sousoulas (Managing Director and Assistant Regional Director)

Hey, good morning. Congrats on the quarter, and thanks for taking the question. I guess maybe a smaller question on the Titan stapler. I know it's still a relatively small piece of the business, but with the Gore buttress material, you know, what are some of the implications on the gross margin for that device? Also, for the manufacturing of that, you know, is there an opportunity to over time, bring that in-house? Thanks for the question.

Liam Kelly (Chairman, President, and CEO)

Yeah, George, thank you very much. First of all, I'd say we're really pleased with the performance of Titan in the first quarter. It drove a lot of the positivity on the surgical business and saw our surgical business perform really, really well as a result, coming in at 14% growth. The buttress material will have no impact on the margin expectations for this business. We still expect this business as we go through 2024 to become accretive to Teleflex's gross margin and then to really leverage thereafter. Our expectation is to continue to have this party or have this product manufactured in the as we have right now, and we have no plans to make any changes to that at this stage.

Obviously, it's ramping pretty rapidly. We don't want to disrupt it, and the third party that we're working with is incredibly reliable and really doing a solid job. Long may that continue and we'll continue to ramp this product through this year, and we still expect it to do $30 million-$35 million in revenue this year. That volume will help us obviously leverage the gross margin as we go into 2024, George. Thanks for the question.

Operator (participant)

As a reminder, that's star followed by one on your telephone keypad to enter the queue. The next question comes from Mike Polark from Wolfe Research. Mike, your line is open. Please go ahead.

Mike Polark (Senior Equity Research Analyst of Medical Devices)

Hey, good morning. Thank you. Maybe follow up there on Standard Bariatrics, and if you said it, I missed it. Can you quantify revenue contribution in the quarter? I know what the full year outlook is for 2023, but I just wanna understand where 1Q started so we can have a better sense for the ramp through the rest of the year.

Liam Kelly (Chairman, President, and CEO)

Yeah, Mike, we don't break it out specifically, in revenue terms. Obviously we are confident on the $30 million-$35 million for the product. I will tell you, as I said a little earlier, it is one of those products that will continue to ramp as you go through the year. Again, we had a really nice start in Q1, therefore it reinforces our confidence on the $30 million-$35 million for the full year. The product is performing very well. We actually showed it at SAGES, we had a lot of really positive feedback from the product at SAGES.

It is addressing a lot of the unmet needs the bariatric surgeons has and the buttress that we're adding to it just overcomes one of those hurdles. Some surgeons just like to use buttress when they're sealing and it's probably not as much needed with the Titan as it is with the other technologies. If that's the process they wanna use, then we're gonna support them in doing that. I think that it all bodes well for the Titan over a multiyear period.

Mike Polark (Senior Equity Research Analyst of Medical Devices)

Thank you. If I can follow up, my other topic was Tyvek. If memory serves, you know, I thought maybe the second half of the year is when that situation might get a little bit better for the industry. It sounds like it's improving in real time. you know, what's driving that? Are you just seeing kind of more supply come online and, you know, how has it trended and, you know, are you back to normal there or pretty darn close? Any kind of framework for where we are?

The related question is, can you just remind us the revenue, the segment lines that have been most impacted by that situation and so, you know, the comps are easiest as that as supply improves. Thank you.

Liam Kelly (Chairman, President, and CEO)

Yeah. I'll use your expression. It's pretty darn close to getting back to normal. It's not quite back to normal yet, Mike, but it is moving positively in the right direction, and it is better than we had anticipated in the first quarter. You are correct. Once we get to the back half of the year, new supply comes on from the provider of Tyvek, that will eliminate the issue. The two lines that are impacted, the two, it's really in our vascular business. It's to a lesser extent, our CVCs, 'cause we prioritize the supply we had to keep our market share position in CVCs. What it has done, it has prevented us from converting PICC accounts.

As you heard in my prepared comments, it was nice to see PICC getting back to double-digit growth in the quarter as we're able to go back out and start converting those accounts. Just to remind investors our PICC portfolio is unique in so far as that it has an antimicrobial and an antithrombogenic coating. Therefore, that's why we're getting broad adoption for that portfolio globally. In particular in the United States, where we're not the market leader, we see a great opportunity to continue to take share.

Operator (participant)

Question comes from Richard Newitter from Truist. Richard, your line is open. Please go ahead.

Richard Newitter (Managing Director and Senior Equity Research Analyst)

Hi. Thanks for taking the question. Just one from me on UroLift. You know, I guess the comments about it's, you know, still some lag on patient flow. I guess even some of the other subcategories in med tech that, you know, improved but are lagging things like elective procedures like knees and hips. Even those kinda saw some of the, you know, the patients coming back into the channel for doctor visits and things of that sort. I'm just curious, is there anything specific about UroLift that contrasts to some of those other procedures? Not UroLift, sorry, but the doctor visit and patient flow.

I'm just trying to get a sense for why maybe, you know, certain urological procedures like this would be still lagging to such an extent versus the rest of the kind of the med tech environment. Thanks.

Liam Kelly (Chairman, President, and CEO)

Well, there's a couple things I'd point out, Rich. First of all, when you're doing hips and knees, you're not doing them to urology patients, so it is unique to the urology specialty. There's a few things with urologists. The average age of a urologist within the United States is 55. It's an aging demographic for the delivery of care. It's, we're probably more exposed to the office side of service than any of the hips and knees guys or even any of our peers in the urology call point. As investors familiar with Teleflex will know, about 30% of our UroLift revenue is generated within the office.

I can tell you that the data that we have will tell us that patient flow declined 3.7% through January and February. The good news, Rich, is that once we get into the latter half of the year and we progress, the toughest comp on patient flow will be behind us as we go through the year. We do anticipate an improving environment from that perspective. It was almost palpable, the enthusiasm for UroLift with urologists at AUA. I was there in Chicago earlier this in late April, compared to a year ago, there was way more attendees. It really felt good. It was buoyant. We had a lot of education seminars. We had a lot of podium presence at that.

I, it was almost, it was back to the good old days of UroLift, I would say at that conference. We do anticipate somewhat of a bounce from that, and we do anticipate the back half of the year being better.

Operator (participant)

A final reminder, that's star followed by one on your telephone keypad to ask a question today. We have no further questions, I'll hand the call back to Lawrence Keusch for any concluding remarks.

Richard Newitter (Managing Director and Senior Equity Research Analyst)

Thank you, Adam, and thank you to everyone that joined us on the call today. This concludes the Teleflex Incorporated First Quarter 2023 Earnings Conference Call.

Operator (participant)

This concludes today's call. Thank you very much for your attendance. You may now disconnect your lines.