Glenn S. Boehnlein
Vice President, Chief Financial Officer at Stryker
Thanks, Preston. Today, I will focus my comments on our first quarter financial results and the related drivers. Similar to last quarter, sales comments will be provided based on our new reporting structure. Our detailed financial results have been provided in today's press release.
Our organic sales growth was 9.2% in the quarter. The first quarter's average selling days were in line with Q1 2021. The impact from pricing in the quarter was unfavorable 1%. Foreign currency had an unfavorable 1.8% impact on sales. During the quarter we saw a recovery of surgical procedures and accelerated sales momentum as the impact of the COVID 19 pandemic has eased in the US and Europe. However, our sales growth has been constrained by continuing supply chain challenges and electronic component shortages especially impacting the capital products in our MedSurg businesses and primarily our medical business. Our capital order book is continuing to be very robust as demand from our customers has continued to be strong. For the quarter, US, organic sales increased by 10.5% reflecting strong double-digit growth in many of our businesses. International organic sales showed growth of 6% impacted by positive sales momentum in Europe and emerging markets somewhat offset by lingering COVID impacts in Australia, Canada, and China. Our adjusted quarterly EPS of $1.97 increased 2.1% reflecting sales growth, partially offset by a higher tax rate and gross margin inflationary pressures. Our first quarter EPS was negatively impacted from foreign currency by $0.02 versus 2021.
Now, I will provide some highlights around our segment performance. In the quarter MedSurg and Neurotechnology had constant currency sales growth of 12.1%, with organic sales growth of 10.8% which included 12.2% of US organic growth. Instruments had US organic sales growth of 16.3% led by strong growth in their Orthopedic Instruments and Surgical Technologies businesses, highlighted by growth in Surg account, Waste Management, smoke evacuation, and Steri-Shield products. Endoscopy had US organic sales growth of 17.7% reflecting strong performances across their portfolio including video products and double-digit growth of their communications and sports medicine businesses. The medical business, which includes our recently acquired Vocera business which closed in February had US organic sales growth of 6.2%, reflecting solid performances in their stage and acute care businesses somewhat offset by the aforementioned supply chain challenges primarily impacting our emergency care products. During the quarter, we also saw significant growth in orders for our acute care and emergency care businesses driven by very strong demand. Assuming normalization of the customer environment and certain -- reduction of certain supply constraints, we expect these orders to contribute to another strong year for Medical in 2022.
Our US neurovascular business posted an organic decline of 1.4% versus a very strong comparable growth of approximately 20% in 2021. The US neuro cranial business posted organic sales growth of 16.6%, which included solid growth in our max space, NSC drills and bio re-absorbable products. Internationally, MedSurg and Neurotechnology had organic sales growth of 7%, reflecting double-digit growth in the endoscopy and Neurovascular businesses. Geographically, this included strong performances in China and Australia. Orthopaedics and Spine had constant currency and organic sales growth of 7.2%, which included 8.2% of organic growth in the US. This reflects the impact of the ramp up in surgical procedures during the quarter. Our hips business grew 8.5% organically in the US, reflecting strong primary hip growth fueled by the launch of our Insignia Hip Stem and improved underlying market dynamics. Our knee business grew 17.5% organically in the US, reflecting the previously mentioned strong recovery of procedures and our market leading position in robotic knee procedures. Our US Trauma and Extremities business grew 10.6% organically, reflecting double-digit growth in foot and ankle, upper extremities and biologics. Our US spine business grew 3.7% organically, led by the performance of our enabling technology products. Other ortho declined organically in the US as the impact of hospital operational staffing challenges and lengthening purchasing cycles limited our ability to place Makos during the quarter. Comparatively in Q1 2021, Other Ortho had growth of 49%. Assuming normalization of the customer environment, we expect another strong year for Mako in 2022. Internationally, Orthopaedics and Spine grew 4.8% organically, which reflects the strong momentum in Europe as surgical procedures ramped up, as well as a strong performance in hips and knees in Japan somewhat offset by lingering COVID challenges in Australia, Canada, and China.
Now, I will focus on operating highlights in the first quarter. Our adjusted gross margin of 64.1% was unfavorable approximately 130 basis points from the first quarter of 2021. Compared to prior year, our gross margin was adversely impacted by purchases of electronic components at premium prices on the spot market and other inflationary pressures primarily related to labor, electronic components, steel, and transportation costs, as well as operational inefficiencies due to the app -- our aforementioned raw material shortages. We expect these adverse impacts to continue throughout 2022 and to be more pronounced in the first half of this year.
Adjusted R&D spending was 7.2% of sales, which represents a 35 basis point increase versus first quarter of 2021, and this reflects our continued commitment to innovation funding and the related future growth that it will provide. Our SG&A was 35.1% of sales, which was 5 basis points lower compared to the first quarter of 2021. This reflects continued cost discipline and fixed cost leverage offset by the ramping of certain expenses and hiring to support future growth.
In summary for the quarter, our adjusted operating margin was 21.8% of sales, which is approximately 160 basis points unfavorable for the first quarter of 2021. This performance is primarily driven by inflationary impacts resulting in gross margin challenges and other continued investments in innovation, somewhat offset by our sales momentum and cost discipline. Other income and expense decreased as compared to the first quarter in 2021 primarily resulting from an equity investment gain as well as lower interest expense. Our first quarter had an adjusted effective tax rate of 13.9%, reflecting the impact of geographic mix and certain discrete tax items. For the full year, we continue to expect an adjusted effective tax rate of 15% to 16%.
Focusing on the balance sheet, we ended the first quarter with $1.5 billion of cash and marketable securities, and total debt of $13.9 billion, which includes the additional $1.5 billion of debt raised to fund the Vocera acquisition. During the quarter, our long-term credit rating in S&P was downgraded from A minus to BBB plus, and our long-term rating at Moody's was reaffirmed at BAA1.
Turning to cash flow, our Q1 cash from operations was $203 million. This performance reflects the results of net earnings and continued focus on working capital management, partially offset by the impact of pre-buying certain electronic component inventory, and approximately $130 million of charges related to the stock compensation payments for the Vocera acquisition that are accounted for in operating cash flow. Given the dynamic supply chain pressures, COVID uncertainty, strong order book for capital equipment, and considering our first quarter results, we now expect full year 2022 organic sales growth towards the high end of our previously guided range of 6% to 8%. This performance assumes that the recovery environment experienced in Q1 continues to improve throughout the rest of the year with a normal procedure environment returning during the second half of the year. If foreign currency exchange rates hold near current levels, we expect net sales in the full year to be adversely impacted by approximately 1.2%.
Adjusted net earnings per diluted share to be adversely impacted by approximately 10. -- $0.10 to $0.15 in the full year, and this is included in our guidance range. Based on our performance in the first quarter and including consideration of the continued supply chain challenges, the inflationary environment and the anticipated impact related to foreign currency, we expect adjusted net earnings -- adjusted earnings per share towards the lower end of our previous guidance range of $9.60 per share to $10 per share. The low end of the guidance range assumes the continued macro environment of volatility persist including inflationary pressures that could impact cost, particularly our cost of sales, and includes more transient spot buying and longer-term supply chain challenges. We will continue to evaluate the changing environment and we'll provide updates to our guidance as necessary.
And now I will open the call up for Q&A.
