Teleflex Q1 2023 Earnings Call Transcript

Presentation

[Operator]

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.

And now I will turn the call over to Mr. Lawrence Keusch, Vice President of Investor Relations and Strategy Development.

[Lawrence Keusch, Vice President of Investor Relations and Strategy Development at Teleflex]

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 will 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.

Now, I will turn the call over to Liam, for his remarks.

[Liam J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

Thank you, Larry and 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, while in actuality slightly in excess of 1% growth and 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 remains 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.

Now, 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 referred 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 up $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 and the year-over-year procedure volumes that fuels broad-based revenue growth across our product portfolio. Now 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 improvement 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 comparison experienced during 2022. As I noted earlier in the call, we saw some improvement in Tyvek supply 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 Medline anticipated share gains from our novel coated PICC portfolio and new product introductions.

Moving to interventional access. Revenue was $116.9 million, up 23.3% year-over-year. We continue 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 foreclosure 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 digit 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 showcase Titan at the recent SAGES Medical Conference and 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, but the office side of service continues to be impacted by staffing shortages. We continue to expect the US end market for UroLift 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 the supply agreement with W. L. Gore & Associates to use the company's GORE SEAMGUARD Bioabsorbabale Staple Line Reinforcement material in a staple line reinforcement device designed by Teleflex for use with the Titan SGS Stapler. Both these material commonly used by surgeons to reduce leaks and bleeding and strengthened 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 materials 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 IV study that examined the rate at which subjects achieved hemostasis to 10 minutes of hemostatic application and compression at the bleeding side. 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 we'll 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 micro catheter 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 Ringer 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 Langston Dual Lumen Catheter. Looking forward, we are actively engaged in expanding our product portfolio with the Wattson, representing the next product anticipated to launch. The Wattson is a unique dual delivery Guidewire 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 PICC 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 TipTacker Technology, use of the DLX eliminates the need for confirmatory X-ray, which reduces time to therapy and cost. In addition, we have launched a new Arrow PICC preloaded with the NaviCurve Stylet. The NaviCurve Stylet features an anatomical curve and flexible tip that are designed to self-orient to patient's anatomy for enhanced PICC advancement into the superior vena cava for successful insertion.

That completes my prepared remarks. Now, I would like to turn the call over to Tom for a more detailed review of our first quarter financial results. Tom?

[Thomas Powell, Executive Vice President and Chief Financial Officer at Teleflex]

Thanks, Liam and 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 1.7 times, which remains well below our 4.5 times 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 and 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 said 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 to $2.956 billion. We are reiterating our 2023 guidance for adjusted earnings per share of $13 to $13.60. We are lowering our GAAP-adjusted earnings per share outlook to $8.14 to $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 J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

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 headwinds. 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 health care 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.

Questions and Answers

[Operator]

Thank you. [Operator Instructions] Our first question today comes from Cecilia Furlong from Morgan Stanley. Cecilia, your line is open. Please go ahead.

[Cecilia Furlong, Analyst at Morgan Stanley & Company]

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

[Liam J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

Thanks for the questions, Cecilia. So I will start at the macro-level for overall procedures. Obviously delivering 13.2% growth in Q1 was ahead of our expectation, extra 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. And what we see overseas in APAC is a strong environment and we see especially as you got through March we saw China start to pickup.

For UroLift specifically, we saw growth again in the hospital side of service, which is encouraging. This is now 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. 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. So 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 already had a really strong presence at AUA and we're encouraged by the enthusiasm we see from urologists.

[Operator]

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

[Shagun Singh Chadha, Analyst at RBC Capital Markets]

Great. Thank you so much for taking the question. So your 2023 revenue guidance, it implies a step down in growth for the balance of the year. So what is driving that outlook? Is it conservatism or is there anything else to call out? And how should we think about the cadence for the balance of the year? Also as we look at EPS, you 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 J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

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. And 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, this is a days' impact. You've got five additional days in the first quarter, you got five less days in quarter four. But 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. And also 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. But we do feel that there is an increased momentum behind Teleflex and our momentum within the marketplace just based on the procedure dynamic, based on some of our key business units and regions performing exceptionally well.

Businesses like OEM, interventional access had really strong margins in the month of March. It's really good to see vascular get back to growth. As expected, we told investors that vascular will get back to growth. It's great to see its 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 procedure volume.

I'll ask Tom to discuss briefly the other part of your question around EPS.

[Thomas Powell, Executive Vice President and Chief Financial Officer at Teleflex]

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

[Operator]

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

[Chris Campbell, Analyst at Jefferies Financial Group]

Hey, how you are doing? This is Chris on for Matt 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 J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

Yeah, absolutely. Chris, thanks for the question. So 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, really well in the first quarter. Came out of the blocks perhaps and intraosseous did in line and PICCs, great to See PICCs come back to growth. As we told investors, once the Tyvek situation started to get better, we would expect PICCs to return to growth and that's exactly what happened within the quarter. PICCs 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 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 portfolios. So that would be our expectation and that's what's contemplated within our guide.

[Chris Campbell, Analyst at Jefferies Financial Group]

Awesome. Appreciate it. Thanks for taking the question.

[Operator]

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

[Michael Matson, Analyst at Needham & Company, LLC]

Yeah. Good morning. Thanks for taking my questions. So I wanted to ask one on UroLift. Did you see the same degree of selling day impact there that you saw in the rest of the business? If you did that would sort of imply fairly decent decline again there kind of mid-single digits, I think? Or is there some reason that didn't benefit UroLift?

[Liam J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

Yeah. So, Mike, the days' impact for UroLift is similar to the rest of the business. So that would -- you're absolutely correct, that would show some modest decline. But, Mike, that's what we were expecting in the first quarter and it came in exactly as we would have anticipated. We did get some analysis on the days' impact. We have it through January and February -- pardon me, on the patient flow impact and we have it through January and February. And 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 worst 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.

[Michael Matson, Analyst at Needham & Company, LLC]

Okay, understand. And then 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 J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

Oh, yeah, the MSA headwind as you go from 2023 into 2024 is approximately $70 million, Mike. But that's lower margin revenue going away. So 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. And 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 investors will see the benefit of that in 2024 as that complete low growth area has gone out of our portfolio, the MSAs 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]

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

[Jayson Bedford, Analyst at Raymond James]

Good morning. Just a couple questions here. OEM and interventional were quite strong with outsized growth. I just want to make sure there is no, kind of, one-timers in there. And then just secondly on OEM. You mentioned pretty good visibility through '23. What kind of growth are you looking at from this segment? Thanks.

[Liam J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

So our OEM business had a stellar start, 34.5%, obviously you got to take the days' 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. And they did have a prior-year easier comp in Q1, which helped them, but the momentum that they carried in from Q4 continued into Q1 and is performing exceptionally well. And 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, again a very strong performance over 23% growth. The return of Langston really helps, complex catheters the GuideLiner, TrapLiner, Turnpike performed well, lot of procedure volume bring us through there. As we go through the year they -- in Q3, they'll comp, the Langston returned to the markets, but notwithstanding that, this is going to be a nice solid growth driver, really good margins.

And as we went through in our prepared remarks, a really nice set up with new products coming through with the GuideLiner Coast, with the Wattson with the Ringer and with the Triumph now coming to market. So, the lifeblood of this business in the past has been new products and we -- 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. So OEM and IA, you're right, Jayson, are the ones that kind of really drove the upside from the expected 6% to 7% within Q1.

[Lawrence Keusch, Vice President of Investor Relations and Strategy Development at Teleflex]

And visibility on OEM?

[Liam J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

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

[Operator]

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

[Anthony Petrone, Analyst at Mizuho Securities USA]

Thanks. Good morning, everyone. Maybe Liam or Tom, just high level comments on procedure volumes. Certainly we saw it in vascular and interventional. A lot of data points in the quarter that we certainly 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. So maybe just a little bit on the sustainability of procedure volumes, broadly as it relates to the other businesses in the hospital, not specifically outpatient. And then I'll have a follow-up as well. Thanks.

[Liam J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

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. But 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. And as I said a little earlier, with China coming back on stream, we would anticipate getting additional growth. I would have 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. And I think to your comment about the other sides 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. And I think it's very encouraging what we're seeing in the hospital side of service.

So 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, Analyst at Mizuho Securities USA]

That's great. And then 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. Maybe just updated thoughts on valuations. And then just also 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 J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

Yeah, Anthony. So we're very active within the markets. Our leverage is now 1.7 times. So we have the most important thing you need when you're doing M&A, we have firepower. So right now we would have the potential, not saying we're going to 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 and I think that we are looking at tuck-ins, 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.

But I think what we're seeing is the cost of funds is improving somewhat. So 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. But 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. Anything you want to add on the cost of funds, Tom?

[Thomas Powell, Executive Vice President and Chief Financial Officer at Teleflex]

Well, I was just going to say that, yes, while certainly the cost of funds are up from where they were a couple of years ago or just a year ago, they are still at fairly reasonable levels overall, based on where we're currently looking at the cost of funds relative to where it's been over the past 10 or 20 years.

So I don't believe right now that that will be an inhibitor to our ability to identify assets. So right now our focus really is, as 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]

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

[Craig Bijou, Analyst at Bank of America Securities]

Good morning, guys. Thanks for taking the question. Wanted to touch on margins. Obviously, you raised revenue guidance but margin guidance didn't change. So, wanted to see if you could walk through the cadence of gross margin, operating margin throughout the year.

And then given the Q1 performance in both gross margin and operating margin, it seems to be better than the prior year, which is trending ahead of your overall guidance for 2023. So why couldn't we potentially see upside to your margin guidance? What are some of the things that we should be considering with margins for the rest of the year?

[Liam J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

Yeah. Craig, thanks for the question. I think one thing, I would just like to point out is, it's May. So 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 got rest, used to say, a good start is half the battle and we've had a good start. But 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, Executive Vice President and Chief Financial Officer at Teleflex]

Sure. So on the gross margin front, you should expect to see a pretty stable gross margin throughout the remainder of the year. It will move-up and down, but not significantly from where it is right now. On the op margin what you should expect to see is sequentially improving operating margin as we go throughout the year.

A couple of things you probably want to keep in mind is that as you look at the kind of comparison to prior year or for the gross margin, we had a more favorable comp in the first quarter than we're going to have for the balance of the year. So 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 the year. In the first quarter, we actually had a nice benefit, but if you recall last year the dollar moved significantly beginning in the second and third quarters and as a result that's going to prove to have a more difficult comparison.

So those are some of the factors I think about. But again, gross margin is pretty stable throughout the year and operating margin show sequential improvement.

[Operator]

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

[George Sellers, Analyst at Stephens]

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, what are some of the implications on the gross margin for that device? And also for the manufacturing of that, is there an opportunity to over time bring that in-house? Thanks for the question.

[Liam J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

Yeah, George, thank you very much. So 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 performed really, really well as a result of 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 '24 to become accretive to Teleflex's gross margin and then to really leverage thereafter. Our expectation is to continue to 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 this and the third-party that we're working with is incredibly reliable and really doing a solid job. So that will continue and we will continue to ramp this product through this year and we still expect it to do $30 million, $35 million in revenue this year and that volume will help us obviously leverage the gross margin as we go into 2024, George. And thanks for the question.

[Operator]

[Operator Instructions] And the next question comes from Mike Polark from Wolfe Research. Mike, your line is open. Please go ahead.

[Mike Polark, Analyst at Wolfe Research]

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

[Liam J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

Yeah, Mike, we don't break it out specifically in revenue terms. Obviously, we are confident on the $30 million to $35 million for the product. And 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. But again, we had a really nice start in quarter one. So therefore, it reinforces our confidence on the $30 million, $35 million for the full year and the product is performing very well.

We actually showed it at SAGES, and we had a lot of really, 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 ceiling. And it's probably not as much needed with the Titan as it is with the other technologies. But if that's the process they want to use then we're going to support them in doing that. So I think that it all bodes well for the Titan over a multi-year period.

[Mike Polark, Analyst at Wolfe Research]

Thank you. If I can follow-up, my other topic was Tyvek. If memory serves, 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. So what's driving that? Are you just seeing kind of more supply come online? And how -- was it kind of -- how does it trended? And are you back to normal there or pretty darn close? Any kind of framework for where we are. And then the related question is, can you just remind us the revenue, the segment lines that are most impact -- have been most impacted by the situation and so the comps are -- where the comps are easiest as that -- as supply improves? Thank you.

[Liam J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

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 and that will eliminate the issue.

The two lines that are impacted, it's really in our vascular business. To a lesser extent our CVCs because 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. And as you heard in my prepared comments, it was nice to see PICCs getting back to double-digit growth in the quarter as we were able to go back out and start converting those accounts.

Just to remind investors, our PICC portfolio is unique in so-far is that it has antimicrobial and anti-thrombogenic coating. So therefore, that's why we're getting broad adoption for that portfolio globally. And in particular in the United States where we're not the market leader, we see a great opportunity to continue to take share.

[Operator]

The next question comes from Richard Newitter from Truist. Richard, your line is open. Please go ahead.

[Richard Newitter, Analyst at Truist Securities]

Hi. Thanks for taking the question. Just one from me. On UroLift, I guess, the comments about still some lag on patient flow. I guess even some of the other sub-categories in med-tech that improve but are lagging things like elective procedures like knees and hips, even though it's kind of -- you saw some of 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 contrast to some of those other procedures, not UroLift, sorry, but the doctor visit and patient flow?

Just trying to get a sense for why maybe 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 J. Kelly, Chairman, President and Chief Executive Officer at Teleflex]

Well, there's a couple of 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 urologists within the United States is 55. So it's an aging demographic for the delivery of care. And we're probably more exposed to the office side of service, than any of the hips and knees guys or any other -- 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.

And I can tell you that the data that we have will tell us that patient flow declined 3.7% through January and February. Now 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. So we do anticipate an improving environment from that perspective.

And it was almost palpable. The enthusiasm for UroLift with urologists at AUA, I was there in Chicago in late April and compared to a year ago there was way more attendees. It really felt good, it was buoyant. We had a lot of education seminars with a lot of podium presence at that. And it was almost back to the good old days of UroLift I would say at that conference. So we do anticipate somewhat of a balance from that and we do anticipate the back half of the year being better.

[Operator]

[Operator Instructions] As we have no further questions, I'll hand the call back to Lawrence Keusch for any concluding remarks.

[Lawrence Keusch, Vice President of Investor Relations and Strategy Development at Teleflex]

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]

[Operator Closing Remarks]

Participants

Corporate Executives

• Lawrence Keusch, Vice President of Investor Relations and Strategy Development
• Liam J. Kelly, Chairman, President and Chief Executive Officer
• Thomas Powell, Executive Vice President and Chief Financial Officer

Analysts

• Cecilia Furlong, Morgan Stanley & Company
• Shagun Singh Chadha, RBC Capital Markets
• Chris Campbell, Jefferies Financial Group Inc.
• Michael Matson, Needham & Company, LLC
• Jayson Bedford, Raymond James
• Anthony Petrone, Mizuho Securities USA
• Craig Bijou, Bank of America Securities
• George Sellers, Stephens
• Mike Polark, Wolfe Research
• Richard Newitter, Truist Securities