Composition of Certain Financial Statement Captions (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Accounts receivable, net
Accounts receivable	$ 136,551	$ 145,665
Less: allowance for doubtful accounts	(1,934)	(1,758)
Accounts receivable, net	134,617	143,907
Inventories, net
Consumable supplies	23,005	23,264
Finished products	25,142	15,259
Work in-process	3,238	2,473
Raw materials	4,586	4,259
Less: inventory reserve	(2,537)	(2,956)
Inventory, net	53,434	42,299
Other current assets and prepaid expenses
Taxes recoverable	19,808	15,708
Other receivables	3,262	2,368
Prepaid supplies	8,147	9,693
Prepaid insurance	3,486	3,436
Other	15,839	3,847
Prepaid expenses and other current assets	50,542	35,052
Property, plant and equipment, net:
Less: accumulated depreciation	(136,445)
Less: accumulated depreciation		(111,662)
Property, plant and equipment, net	127,111
Property, plant and equipment, net		144,674
Intangible assets, net:
Less: accumulated amortization	(298,234)	(258,539)
Intangible assets, net	528,962	614,452
Accrued expenses:
Contract liabilities	19,196	63,503
Employee benefits	33,671	45,621
Commitments and Contingencies	38,635	15,327
Clinical trials	8,122	10,401
Professional fees	1,333	2,952
Finance leases short-term	2,743
Finance leases short-term		3,280
Milestone payment	0	4,871
Contingent consideration	2,375	2,375
Other	58,850	55,183
Accrued expenses	164,925	203,513
Other long-term liabilities:
Line of credit	44,749	105,198
Contract liabilities	2,571	27,566
Contingent consideration	7,308	22,162
Finance leases long-term	4,046
Finance leases long-term		5,620
Mortgages and other debts payable	3,906	4,654
Other	25,224	33,768
Other long-term liabilities	87,804	198,968
Customer relationships
Intangible assets, net:
Intangible assets	445,408	446,296
Technologies
Intangible assets, net:
Intangible assets	296,246	340,729
Trade names
Intangible assets, net:
Intangible assets	49,786	50,404
Covenants not to compete
Intangible assets, net:
Intangible assets	16,318	16,322
Licenses
Intangible assets, net:
Intangible assets	5,766	5,766
Product registrations
Intangible assets, net:
Intangible assets	7,578	7,861
Other
Intangible assets, net:
Intangible assets	6,094	5,613
Machinery, medical and other equipment
Property, plant and equipment, net:
Property, plant and equipment, gross	165,501
Property, plant and equipment, gross		147,757
Leasehold improvements
Property, plant and equipment, net:
Property, plant and equipment, gross	33,606
Property, plant and equipment, gross		34,607
Furniture and fixtures
Property, plant and equipment, net:
Property, plant and equipment, gross	12,631
Property, plant and equipment, gross		12,737
Automobiles and aircraft
Property, plant and equipment, net:
Property, plant and equipment, gross	10,029
Property, plant and equipment, gross		10,133
Software
Property, plant and equipment, net:
Property, plant and equipment, gross	13,861
Property, plant and equipment, gross		13,425
Building
Property, plant and equipment, net:
Property, plant and equipment, gross	18,462
Property, plant and equipment, gross		18,554
Land
Property, plant and equipment, net:
Property, plant and equipment, gross	2,422
Property, plant and equipment, gross		2,453
Construction in process
Property, plant and equipment, net:
Property, plant and equipment, gross	$ 7,044
Property, plant and equipment, gross		$ 16,670