Baxter delivered third quarter sales growth of 9% on a reported basis, 7% at a constant currency and 6% operationally.
On the bottom line, third quarter adjusted earnings per share were $1.02, up 23% and exceeded our third quarter guidance.
Looking at performance by business, growth was led by BioPharma Solutions which advanced 45% at constant currency rates.
Medication Delivery grew at 11% constant currency, reflecting the improved rate of U.S. hospital admissions in new infusion pump contract with a large health system in the U.S. and increased demand for Baxter's small volume parenterals.
With respect to our NOVUM IQ 510(k) submission, we are continuing to work with the FDA to address their questions on our submission.
In Pharmaceuticals, 7% constant currency growth reflects the benefit of our acquisition of specified rights outside the U.S. to Caelyx and Doxil.
Adjusting results for the acquisition, operational growth rose 1%.
A $1.5 million foundation grant is helping fund the multifaceted 3-year program.
Third quarter 2021 global sales of $3.2 billion, advanced 9% on a reported basis, 7% on a constant currency basis and 6% operationally.
Sales growth this quarter reflects the benefit from revenues associated with the manufacturing of COVID vaccines, strength in medication delivery and OUS sales of Caelyx and Doxil, which totaled approximately $32 million in the quarter.
On the bottom line, adjusted earnings increased 23% and to $1.02 per share, exceeding our guidance range, driven by a favorable product mix, primarily from better-than-expected sales of Acute Therapies and BioPharma Solutions as well as disciplined operational execution.
Sales in the Americas increased 7% on both the constant currency and operational basis.
Sales in Europe, Middle East and Africa grew 7% on a constant currency basis and 3% operationally.
And sales in our Asia Pacific region advanced 8% on both a constant currency and operational basis.
Global sales for Renal Care were $981 million increased 1% on a constant currency basis.
We continue to monitor the impact of excess mortality among ESRD patients and delays in new patient diagnosis resulting from the pandemic and expect the market to return to pre-COVID growth rates over the next 12 to 24 months.
Medication delivery of $747 million increased 11% on a constant currency basis.
During the quarter, we estimate that U.S. hospital admissions were down approximately 4% compared to pre-COVID levels, a significant improvement from the same quarter last year, which saw U.S. admissions down approximately [Technical Issues] versus pre-Covid levels.
Pharmaceutical sales of $589 million advanced 7% on a constant currency basis and 1% operationally.
This growth was partially offset by declines in our U.S. business related to lower surgical procedures and a government order of approximately $20 million in Q3 2020.
Moving to Clinical Nutrition, total sales were $244 million, increasing 3% on a constant currency basis.
Sales in Advanced Surgery were $249 million, increasing 5% on a constant currency basis.
This growth was partially offset by performance in the U.S. with surgical procedures estimated at 95% of pre-COVID levels, a sequential and year-over-year decline in surgical procedure volumes due to the impact of the Delta variant and staff shortages.
Sales in our Acute Therapies business were $185 million, advancing 3% on a constant currency basis and were favorable to our expectations.
BioPharma Solutions sales in the quarter were $206 million, representing growth of 45% on a constant currency basis, reflecting incremental sales related to the manufacturing of COVID vaccines, which totaled more than $50 million in the quarter.
Our adjusted gross margin of 44% increased by 140 basis points over the prior year, reflecting a favorable product mix and operational improvements in manufacturing.
Adjusted SG&A of $640 million increased 11% as compared to the prior year period and was favorable to expectations, driven by disciplined expense management, which more than offset increased supply chain and logistics expenses recognized in the quarter.
Adjusted R&D spending in the quarter of $129 million increased 6% versus the prior year period.
This improvement in gross margin, coupled with the continued opex management resulted in an adjusted operating margin in the quarter of 20.2%, an increase of 100 basis points versus the prior year.
Adjusted net interest expense totaled $32 million in the quarter and other nonoperating expense was $12 million in the quarter.
The adjusted tax rate in the quarter was 14.8%, a decrease over the prior year, driven primarily by a favorable change in earnings mix.
And as previously mentioned, adjusted earnings of $1.02 per diluted share exceeded our guidance of $0.93 to $0.95 per diluted share.
With respect to cash flow, year-to-date, we've generated $1.5 billion in operating cash flow.
Free cash flow totaled over $1 billion and represented growth of nearly 50% as compared to the prior year period.
For full year 2021, we expect global sales growth of 7% to 8% on a reported basis, 5% to 6% on a constant currency basis and 4% to 5% on an operational basis.
This assumes a benefit of approximately 100 basis points to both reported and constant currency revenue growth for the acquisition of Caelyx/Doxil and over 200 basis points of positive top line impact from foreign exchange on reported growth.
Moving down the P&L, we now expect adjusted operating margin to expand more than 60 basis points.
For the year, we now expect an adjusted tax rate of 16.5% to 17% and a full year diluted average share count of approximately 510 million shares.
Based on these factors, we now expect 2021 adjusted earnings, excluding special items, of $3.58 to $3.62 per diluted share.
For the fourth quarter of 2021, we expect global sales growth of 3% to 4% on a reported basis, 4% to 5% on a constant currency basis and 3% to 4% on an operational basis.
And we expect adjusted earnings, excluding special items, of $1 to $1.04 per diluted share.

Summary:
Third quarter 2021 global sales of $3.2 billion, advanced 9% on a reported basis, 7% on a constant currency basis and 6% operationally.
For full year 2021, we expect global sales growth of 7% to 8% on a reported basis, 5% to 6% on a constant currency basis and 4% to 5% on an operational basis.
Based on these factors, we now expect 2021 adjusted earnings, excluding special items, of $3.58 to $3.62 per diluted share.
And we expect adjusted earnings, excluding special items, of $1 to $1.04 per diluted share.