Intuitive Surgical investors must be waiting for the other shoe to drop. Despite reporting 19% procedure growth in the first quarter (well above analyst's expectations), shares nosedived in after-hours trading Thursday, then continued to fall Friday. The stock was down 14.3% ($42.23) at market close Friday.

Still, analysts seemed impressed by the quarter's procedure growth. Intuitive also raised its procedure guidance for the year to between 12% and 16%.

"In the end, procedure growth rules the day," Ryan Zimmerman, a medtech analyst at BTIG, wrote in a report Thursday night.

Zimmerman attributed the drop in shares to "bearish commentary" during Intuitive's earnings call regarding the capital spending environment at U.S. hospitals as well as supply chain headwinds.

"[Intuitive Surgical] continues to ramp up operating expenses and investors do not want to see EPS come down but [Intuitive Surgical's] long-term strategy remains unchanged. We believe the company is well-positioned to continue growing procedures, and we view shares as attractive as recovery ensues," Zimmerman noted.

BTIG maintains a "buy" rating on Intuitive Surgical, although the firm did lower its price target to $355 from $360.

Intuitive Surgical CEO Gary Guthart said procedure performance was driven by general surgery procedures in the United States, and non-urology procedures outside of the United States, which he said are the company's areas of focus.

"Regardless of the health of procedure demand, we are challenged by environmental stresses, including regional waves of COVID, staffing pressure at hospitals, component and raw material availability, and logistic delays," Guthart said.

For additional insight into the ongoing supply chain crisis, check out this bonus episode of Let's Talk Medtech, recorded at IME West 2022:

The company is also seeing less capital spending from U.S. hospitals, which may indicate some "budget flushing" as hospitals get ready for the retirement of some of the COVID-related government support, Guthart said.

"But it's not clear. We don't know yet," he said.

On the bright side, Guthart said procedure demand is the core driver of capital equipment purchases in a mature multiport market segment in a country like the United States, and Intuitive's procedure demand is healthy.

"Our major focus is making sure that we can supply the customer with what they need in a way that's high quality and timely," he said. "So, it's really managing the supply chain. If that goes well and we are successful in closing those gaps, I think capital demand will work itself out. It will play through because it ultimately in those markets is driven by core procedure demand."

Intuitive Surgical CFO Jamie Samath said the company is replenishing inventory where it can and as supply lasts, but "we have an imbalance currently."

"Certainly, if you look at the medium to long term, we're going to look carefully at what levels of inventory we want to hold as one risk mitigation," Samath said. "I think the other thing we'll look at is how do we make ourselves less dependent on sole suppliers."