Thank you, Chad, good morning, everyone. Speaking on today's call will be Karen Burton, our Senior Vice President and CFO, and Dan Carestio, our President and CEO. I do have a few words of caution before we open for comments. This webcast contains time-sensitive information that is accurate only as of today. Any redistribution, retransmission, or rebroadcast out of this call without the express written consent of STERIS is strictly prohibited. Some of the statements made during this review are or may be considered forward-looking statements. Many important factors could cause actual results to differ materially from those in the forward-looking statements, including without limitation, those risk factors described in STERIS's securities filings. The company does not undertake to update or revise any forward-looking statements as a result of new information or future events or developments. STERIS's SEC filings are available to the company and on our website.
In addition, on today's call, non-GAAP financial measures, including adjusted earnings per diluted share, adjusted operating income, constant currency organic revenue growth, and free cash flow will be used. Additional information regarding these measures, including definitions, is available in our press release, as well as reconciliations between GAAP and non-GAAP financial measures. Non-GAAP financial measures are presented during this call with the intent of providing greater transparency to supplemental financial information used by management and the board of directors in their financial analysis and operational decision-making. With those cautions, I will hand the call over to Karen.
Thank you, Julie. Good morning, everyone. It is my pleasure to be with you this morning to review the highlights of our fourth quarter performance from continuing operations. As anticipated, we ended this strong year with a lighter fourth quarter. For the fourth quarter, total as-reported revenue grew 7%. Constant currency organic revenue grew 5% in the quarter, driven by volume as well as 230 basis points of price. Gross margin for the quarter was 44%, down 30 basis points versus the prior year. We continued to realize positive pricing, which helped mitigate the impact of higher tariffs and inflation. EBIT margin for the quarter was 24.2% of revenue, a high for fiscal 2026. This was 60 basis points below the fourth quarter last year, mainly driven by inflation and tariffs.
Incremental tariffs impacted our fourth quarter by approximately $10 million, which was below our expectations due to lower volumes in materials and products sourced from outside the U.S. The adjusted effective tax rate in the quarter was 25.4%, an increase from 23.5% in the fourth quarter last year. The year-over-year increase was driven primarily by changes in geographic mix and unfavorable discrete items. Adjusted net income from continuing operations in the quarter was $278.3 million. Earnings per diluted share from continuing operations were $2.83, a 3% increase over the prior year as the lower margin and higher tax rate limited earnings growth in the quarter. Before I turn to cash flow for the year, I want to dig into the upward pressure on our tax rate for a moment.
For the full year fiscal 2026, our adjusted effective tax rate was 24.4%, an increase of 130 basis points from fiscal 2025. Our tax rate varies based on many factors, most notably geographic profit mix and discrete item adjustments, which include withholding taxes. Since we generate the majority of our profit in the U.S., it is common that we need to move cash across borders to deploy capital. This movement may trigger U.S. withholding taxes. Our fiscal 2027 guidance assumes that in accordance with our capital allocation priorities, we will increase the dividends, reinvest in our business, invest to grow through M&A, and return excess cash to shareholders through our share buyback program. To fund some of these priorities, we expect to incur additional withholding tax, putting further upward pressure on our effective tax rate.
This is reflected in our estimate of 25% in fiscal 2027. Capital expenditures for fiscal 2026 totaled $369 million, and depreciation and amortization totaled $486.5 million. We ended the year with a strong balance sheet reflecting $1.9 billion in total debt. Gross debt-to-EBITDA at year-end was approximately 1.2x, well below our targets of 2x-2.5x. Free cash flow for fiscal 2026 was exceptional at $982.9 million, with year-over-year improvement driven primarily by an increase in earnings, which more than offset the significantly lower contribution from working capital in fiscal 2026 compared with fiscal 2025.
To provide some context, recall that the working capital improvement that we generated in fiscal 2025 was primarily the result of targeted inventory reductions as we recovered from supply chain challenges. Going forward, we would expect our working capital will grow in line with volume. Once again, we are heading into a new fiscal year in a strong financial position with continued commitment to our capital allocation priorities. With that, I will now turn the call over to Dan for his remarks.
Thanks, Karen. Good morning, everyone. Thank you for joining us to hear more about our fiscal 2026 performance and our outlook for fiscal 2027. Karen covered the quarter at a high level. I will add some commentary on the year and then comment on our outlook. Fiscal 2026 was another record year for STERIS with 9% revenue growth, 7% on a constant currency organic basis. We are pleased to have translated this into 10% adjusted earnings per share growth despite the 80 basis points of impact from tariffs on margins. Our businesses all hit new milestones this year, contributing to total company revenue of approximately $6 billion and adjusted net income topping $1 billion.
This is an exciting time to be at STERIS, and we expect to continue to grow the business mid to high single digits organically over time and leverage that to deliver double-digit bottom-line growth. Supporting our growth, U.S. procedure volume continues to grow mid-single digits, a level we expect to be consistent in fiscal 2027. Procedure volume outside of the U.S. do continue to lag a bit, which impacts our AST segment a little bit more than Healthcare. From a segment perspective, Healthcare reported another strong year, growing 9% as reported and 8% from a constant currency organic perspective. This growth was driven by another remarkable year for service, growing 12%, as well as 7% growth in consumables as we continue to pick up share thanks to the breadth of our portfolio and the performance of our commercial teams.
Capital equipment also grew nicely, up 6% for the year, stabilizing after the last several years of lumpiness. Capital equipment backlog ended just under $400 million, with orders up 2% in the fourth quarter. This year, we reached new milestones in Healthcare business, generating $4 billion in revenue and $1 billion in operating income. We continue to be excited about what is yet to come as we expand our offering through organic and inorganic growth to deliver products and services that address the most pressing operational needs of our customers. AST grew 10% as reported and 7% constant currency organic. This was a bit lighter than what we had anticipated with softness in the second half of the year, in particular, a slower fourth quarter for services due to the severe snowstorms in the U.S. early in the calendar year.
For the year, our services business grew 11% as reported, or about 8% constant currency organic, which aligns with our expectations for the business going forward. With over $1 billion in revenue, AST crossed a new milestone of its own, exceeding $500 million in operating profit. Life Sciences grew 9% as reported and 7% constant currency organic, driven by 15% growth in capital equipment as our customers returned to capital investment again following last year's downturn. Consumables continued their steady path of growth at 8%, and services improved 5% despite some more quarterly volatility than we usually see. Capital equipment backlog ended solid at just under $100 million. Life Sciences posted its own record year, exceeding $250 million in operating profit for the first time, reflecting strong operating margins.
Total company EBIT margins expanded by 10 basis points to 23.3% for fiscal 2026, despite incremental tariff costs of approximately $46 million, which trimmed our margin by 80 basis points. Lower interest contributed to our double-digit growth in adjusted earnings at $10.17 per diluted share. We also stayed true to our capital deployment priorities this year. We increased the quarterly dividend $0.06 to $0.63, our 20th year of dividend growth. We invested in ourselves, in particular in AST expansions projects for X-ray globally. In addition, we completed two tuck-in acquisitions that add to our healthcare portfolio globally. Last but not least, we used $225 million for share buybacks. As you saw in our press release, the board has approved a new $1 billion buyback authorization.
Going forward, we expect to utilize excess cash to consistently buy back shares in the range of $200 million-$300 million per year. Turning to our outlook for fiscal 2027. As noted in the press release, we anticipate as-reported revenue to grow 7%-8% in fiscal 2027. Changes in foreign currency are expected to be slightly favorable to STERIS. Tuck-in acquisitions and healthcare are contributing inorganic revenue to our as-reported outlook for the segment and total company. There are two acquisitions driving this contribution. In the fourth quarter, we vertically integrated our supplier for MEDglas Walls, extending our reach from the U.S. to global. In addition, early in the first quarter, we acquired a family of GI products that expanded our offering and improved our channel. These two acquisitions are expected to contribute combined revenues of approximately $45 million to fiscal 2027.
As a result, constant currency organic revenue growth is expected to be 6%-7% for the total company. This outlook assumes approximately 200 basis points of price. From a segment perspective, we anticipate Healthcare and Life Sciences to grow 6%-7% constant currency organic and AST to grow 7%-8%. We are taking a more conservative approach on our outlook to AST to start the year. Our MedTech customers continue to manage inventory levels carefully, and we are heading into the new year with some difficult comparisons in the first half, leaving us cautious. For fiscal 2027, EBIT margins are anticipated to expand approximately 50 basis points at the high end of our outlook. This assumes tariff spending is flat year-over-year and the benefit of a tailwind from our Incentive Compensation program.
We will be making select investments in FY 2027, driving incremental operating expenses, including kicking off a multiyear project to support our service workflows with upgraded technologies utilizing AI to improve quality, increase productivity, and enhance the customer experience within both the healthcare and life science segments. Our fiscal 2027 earnings per share outlook is $11.10-$11.30, growth of 9%-11% over fiscal 2026. In fiscal 2027, free cash flow is expected to be $850 million and CapEx of $375 million. Underlying our free cash flow expectations, we expect that net working capital will grow in line with volumes. We will also use about $50 million for additional incentive compensation payments due in June and the remainder of our EO settlement payments over the year.
From a capital perspective, our capital spending priorities are shifting a bit as we are nearly done with our multi-year X-ray expansion in AST. In fiscal 2027, we will build a new sterility assurance manufacturing plant in Mentor, Ohio, which will ultimately allow us to consolidate existing U.S. production into one new state-of-the-art manufacturing center of excellence to serve our healthcare and life science customers. We will invest about $60 million over two years and expect that plant to be operational by the end of calendar 2027. Fiscal 2026 was a banner year in many ways for STERIS. Looking back at the last five years, our performance has really been remarkable.
We delivered average constant currency organic revenue growth of 9%, and our compounded annual growth rate for adjusted earnings was 11% during what was one of the more tumultuous five years in our history here. Equally important, our healthcare organization has transformed from a products and services focus to a valued partner to healthcare customers to help enable them to solve some of their most pressing operational challenges that they are facing. We are committed to partnering with our customers to enable them to meet their procedural growth needs, improve the delivery of the quality outcomes, and improve standardization and optimization as they manage critical inventory from the OR to the SPD and back. Thank you to all of our associates for continuing to do what you do best, focus on our customers, and strive to do better every single day.
That concludes our prepared remarks for the call. Operator, would you please give the instructions so we can begin the Q&A?