Menorrhagia
Conditions
Keywords
Abnormal Uterine Bleeding associated with fibroids, AUB-L, Fibroids, Heavy menstrual bleeding, HMB, Myoma, Menorrhagia
Brief summary
The objective of this study is to establish the safety and effectiveness of the Sonata® System in the treatment of symptomatic uterine fibroids.
Detailed description
In this single-arm study, subjects who have symptomatic uterine fibroids will have transcervical RF ablation of uterine fibroids under intrauterine ultrasound guidance using the Gynesonics Sonata System.
Interventions
DEVICEIntrauterine Ultrasound-Guided Radiofreq. Ablation System
The Sonata System combines intrauterine ultrasound (IUUS) with radiofrequency (RF) ablation in a single handpiece. Sonata is suitable in an inpatient or outpatient setting, and is intended for diagnostic intrauterine imaging and transcervical treatment of symptomatic uterine fibroids, including those associated with heavy menstrual bleeding(HMB).
Sponsors
Gynesonics
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
25 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* premenopausal * ≥ 25 and ≤ 50 years of age at time of enrollment * experienced heavy menstrual bleeding associated with fibroids (AUB-L) for at least 3 months * between 1-10 fibroids of FIGO types 1, 2, 3, 4, and/or type 2-5, with diameter ≥ 1.0 cm and ≤ 5.0 cm * at least one type 1, type 2, type 3, or type 2-5 fibroid. * PBAC score ≥ 150 and ≤ 500 * consistent menstrual cycles * not at material risk for pregnancy * speaks and reads a language for which validated questionnaires are available * willing and able to read, understand, and sign the informed consent form, to participate in the study and to adhere to all study follow-up requirements
Exclusion criteria
* pregnancy * urgent need for surgery to treat fibroid symptoms * desire for current or future childbearing * presence of a tubal implant for sterilization * postmenopausal by history * presence of type 0 fibroids, unless \< 1 cm in diameter * presence of a single polyp ≥ 1.5 cm, or multiple polyps of any size * any fibroid of FIGO type 1, type 2, type 3, type 4, or type 2-5 with diameter \> 5.0 cm * bulk symptoms in the presence of one or more fibroids of FIGO type 5, type 6, or type 7 * exclusive presence of fibroids that are insufficient to explain the severity of symptoms * presence of clinically relevant fibroids that cannot be treated for technical reasons * presence of an extrauterine pelvic mass that has not been diagnosed as benign * IUD/IUS in situ within the washout period * previous procedure for fibroids or heavy menstrual bleeding other than myomectomy * myomectomy within 12 months * any abnormality of the endometrial cavity that obstructs access of the handpiece * contraindication to MRI * total uterine volume \> 1000 cc * clinically significant adenomyosis * confirmed or suspected diagnosis of clinically relevant endometriosis * one or more clinically relevant fibroids that are significantly calcified. * previous pelvic irradiation * renal insufficiency \[serum creatinine ≥ 1.5 mg/dL (132.6 μmol/L)\] * evidence of disorders of hemostasis (AUB-C) * abnormal cervical cytology that is unevaluated or untreated in adherence with national guidelines * endometrial hyperplasia (AUB-M), including simple hyperplasia without atypia * confirmed abdominal / pelvic malignancy within the previous five years * active pelvic infection or current positive testing for pelvic gonorrhea or chlamydia; * use of a hormonally-relevant medication within the washout period * use of an antifibrinolytic agent while undergoing any screening procedures * current use of anticoagulant therapy * chronic pelvic pain (disruptive for at least six months) or significant baseline pelvic or menstrual pain * chronic uncontrolled moderate and severe hypertension * hypoplastic or otherwise short uterus * major medical or psychiatric illness or other factors that may affect general health or subject's ability to adhere to the follow-up schedule or provide valid subject self-assessment data * any other reason for which the individual study subject is not appropriate or suitable for participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Subjects With ≥ 50% Reduction in Menstrual Blood Loss as Assessed by Pictorial Blood Loss Assessment Chart (PBAC) | Baseline and 12 Months | The proportion of subjects with a minimum of 50% reduction in menstrual blood loss at 12 months post-procedure compared to baseline as assessed by PBAC. Success for individual subjects was defined as a ≥ 50% reduction from baseline in menstrual blood loss and a final PBAC score \< 250. Endpoint success was defined as the lower confidence limit of the percentage of subject success ≥ 45%. The PBAC is a validated tool used to diagnose heavy menstrual bleeding and track menstrual bleeding. Women were asked to record daily use of tampons and sanitary towels by placing a tally mark under the day next to the box that represented how stained the sanitary materials were each time they were changed during the menstrual cycle. The tally marks were added up depending on the saturation level to provide a score. The score does not have an upper limit as it is not a scale. PBAC ≥ 150 is associated with heavy menstrual bleeding. |
| Percentage of Subjects Without Surgical Re-intervention for Heavy Menstrual Bleeding Due to Treatment Failure | 12 Months | This endpoint computed the rate of not having a surgical reintervention for heavy menstrual bleeding due to treatment failure. As the success criterion for this endpoint was no surgical reintervention for HMB due to treatment failure at 12 months, the endpoint assessed the rate of subjects without surgical reintervention success due to treatment failure within the 12-month post-treatment period. Rate was calculated using the life-table method. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in the Symptom Severity Score (SSS) and Quality of Life (HR-QoL) Subscales of the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) Questionnaire at 12 Months | Baseline and 12 Months | The Symptom Severity Score (SSS) and Health-Related Quality of Life Score (HR-QoL) are calculated from a subset of the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) questionnaire, a validated and fibroid-specific assessment tool. The UFS-QoL is a uterine fibroid-specific questionnaire developed to evaluate the symptoms of uterine fibroids and their impact on quality of life related to health. SSS and HR-QoL subscale scores are summed and transformed into a 0-100 point scale. The SSS and HR-QoL subscale scores are inversely related with higher SSS indicating greater symptoms while higher HR-QoL scores indicate better quality of life. |
| Time to Return to Normal Activity (RTNA) in Days | 30 Day post-procedure | Subjects were given a questionnaire at discharge and asked to daily respond to the questionnaire on whether or not they returned to normal activities. |
| Overall Treatment Effect (OTE) at 12 Months | 12 Months | The Overall Treatment Effect is a questionnaire for subjects to report their perceived treatment benefit at a given timepoint as either improved, no change, or worsened. |
| Subject Satisfaction With Treatment at 12 Months | 12 Months | Subjects were asked to rate their level of satisfaction with the treatment. The possible ratings were as follows: very satisfied, moderately satisfied, somewhat satisfied, somewhat dissatisfied, moderately dissatisfied, and very dissatisfied. |
| Subject Willingness to Recommend Procedure at 12 Months | 12 Months | Subjects were asked whether they would recommend the procedure to a friend with the same health problems. The possible responses were: definitely yes, probably yes, probably no, and definitely no. |
| Change in General Health State at 12 Months | Baseline and 12 Months | Change in general health state was assessed with the EuroQOL EQ-5D. The EQ-5D is a standardized instrument for use as a measure of health outcome. Applicable to a wide range of health conditions and treatments, EuroQOL EQ-5D provides a simple descriptive profile and a single index value for health status. The EQ-5D consists of five questions that provide a description of the patient's health state with scores ranging from 0 (indicating death) to 1 (indicating perfect health). An increase of 0.04 in EQ-5D is considered by health economists to represent a minimally important difference. |
| Safety - Percentage of Subjects With Adverse Device Effects (Serious or Non-serious) | Each Follow-up Visit through 24 Months | Procedure safety was assessed by recording all adverse device effects that occured during or subsequent to treatment on the day of the procedure. Longer-term safety was assessed by recording any untoward medical occurrence since baseline at each follow-up visit. |
| Procedure Tolerance | Post-procedure (Day 0) | Prior to discharge, subjects were asked to rate their tolerance of the procedure. The possible responses were very tolerable, moderately tolerable, minimally tolerable, intolerable. |
| Mean Length of Stay | Day 0 - Day of Treatment | Length of stay (in hours) was assessed by recording the duration from the start of the procedure to discharge. |
| Occurrence of Pregnancy | All Follow-up Visits through 24 Months | Subjects were asked about the possible occurrence of pregnancy. |
| Pregnancy Outcome - Gestation Age | 24 Months | If pregnancy occurred during the study follow-up period, information regarding gestation age was collected. |
| Pregnancy Outcome - Birth Weight | 24 Months | If pregnancy occurred during the study follow-up period, information regarding birth weight was collected. |
| Change in Work Productivity and Activity Impairment Due to Uterine Fibroid Symptoms at 12 Months | Baseline and 12 Months | The Work Productivity and Activity Impairment questionnaire for a specific health problem (WPAI:SHP) is a standardized instrument for making a quantitative assessment of work impairment and activity impairment attributable to a specific health problem (WPAI:SHP). The assessments are expressed in percentages. The endpoint assessed the difference in these percentages from baseline to 12 months. |
| Subject Pain | Immediately Post-procedure as well as Pre-discharge (Day 0) | Prior to discharge, subjects were asked to rate their experience of pain using a pain Visual Analog Scale (VAS). The VAS for pain is a measurement instrument by which subjects report the intensity of their pain with a quantitative value from 0 (no pain) to 10 (worst pain ever). |
| Percentage Change in Total and Perfused Mean Maximal Fibroid Volumes at 12 Months | Baseline and 12 Months | The percent change in total and perfused volume of dominant fibroid were determined by comparing contrast-enhanced MRI at baseline and at 12 months. |
Countries
Mexico, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Sonata Subjects treated with Sonata System. | 147 |
| Total | 147 |
Baseline characteristics
| Characteristic | Sonata |
|---|---|
| Age, Continuous | 42.9 years STANDARD_DEVIATION 4.28 |
| Pictorial Blood Loss Assessment Chart | 300.6 Index STANDARD_DEVIATION 98.47 |
| Race/Ethnicity, Customized Black or African American | 49 Participants |
| Race/Ethnicity, Customized Hispanic or Latino | 43 Participants |
| Race/Ethnicity, Customized White | 60 Participants |
| Region of Enrollment Mexico | 22 Participants |
| Region of Enrollment United States | 125 Participants |
| Sex: Female, Male Female | 147 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 147 |
| other Total, other adverse events | 60 / 147 |
| serious Total, serious adverse events | 2 / 147 |
Outcome results
Primary
Percentage of Subjects With ≥ 50% Reduction in Menstrual Blood Loss as Assessed by Pictorial Blood Loss Assessment Chart (PBAC)
The proportion of subjects with a minimum of 50% reduction in menstrual blood loss at 12 months post-procedure compared to baseline as assessed by PBAC. Success for individual subjects was defined as a ≥ 50% reduction from baseline in menstrual blood loss and a final PBAC score \< 250. Endpoint success was defined as the lower confidence limit of the percentage of subject success ≥ 45%. The PBAC is a validated tool used to diagnose heavy menstrual bleeding and track menstrual bleeding. Women were asked to record daily use of tampons and sanitary towels by placing a tally mark under the day next to the box that represented how stained the sanitary materials were each time they were changed during the menstrual cycle. The tally marks were added up depending on the saturation level to provide a score. The score does not have an upper limit as it is not a scale. PBAC ≥ 150 is associated with heavy menstrual bleeding.
Time frame: Baseline and 12 Months
Population: Full Analysis Population (143) minus 1 subject who had surgical reintervention prior to 12 months and was excluded from analysis of bleeding reduction coprimary endpoint per the Statistical Analysis Plan.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Subjects Treated With Sonata | Percentage of Subjects With ≥ 50% Reduction in Menstrual Blood Loss as Assessed by Pictorial Blood Loss Assessment Chart (PBAC) | 64.8 percentage of participants |
Primary
Percentage of Subjects Without Surgical Re-intervention for Heavy Menstrual Bleeding Due to Treatment Failure
This endpoint computed the rate of not having a surgical reintervention for heavy menstrual bleeding due to treatment failure. As the success criterion for this endpoint was no surgical reintervention for HMB due to treatment failure at 12 months, the endpoint assessed the rate of subjects without surgical reintervention success due to treatment failure within the 12-month post-treatment period. Rate was calculated using the life-table method.
Time frame: 12 Months
Population: Full Analysis Population (143 subjects)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Subjects Treated With Sonata | Percentage of Subjects Without Surgical Re-intervention for Heavy Menstrual Bleeding Due to Treatment Failure | 99.3 Percentage of Participants |
Secondary
Change in General Health State at 12 Months
Change in general health state was assessed with the EuroQOL EQ-5D. The EQ-5D is a standardized instrument for use as a measure of health outcome. Applicable to a wide range of health conditions and treatments, EuroQOL EQ-5D provides a simple descriptive profile and a single index value for health status. The EQ-5D consists of five questions that provide a description of the patient's health state with scores ranging from 0 (indicating death) to 1 (indicating perfect health). An increase of 0.04 in EQ-5D is considered by health economists to represent a minimally important difference.
Time frame: Baseline and 12 Months
Population: Full Analysis Population without imputation for this outcome measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Subjects Treated With Sonata | Change in General Health State at 12 Months | 0.17 units on a scale | Standard Deviation 0.223 |
Secondary
Change in the Symptom Severity Score (SSS) and Quality of Life (HR-QoL) Subscales of the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) Questionnaire at 12 Months
The Symptom Severity Score (SSS) and Health-Related Quality of Life Score (HR-QoL) are calculated from a subset of the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) questionnaire, a validated and fibroid-specific assessment tool. The UFS-QoL is a uterine fibroid-specific questionnaire developed to evaluate the symptoms of uterine fibroids and their impact on quality of life related to health. SSS and HR-QoL subscale scores are summed and transformed into a 0-100 point scale. The SSS and HR-QoL subscale scores are inversely related with higher SSS indicating greater symptoms while higher HR-QoL scores indicate better quality of life.
Time frame: Baseline and 12 Months
Population: Full Analysis Population without imputation for this outcome measure.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Subjects Treated With Sonata | Change in the Symptom Severity Score (SSS) and Quality of Life (HR-QoL) Subscales of the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) Questionnaire at 12 Months | Mean Change in SSS at 12 Months | -32.1 points on a scale | Standard Deviation 21.03 |
| Subjects Treated With Sonata | Change in the Symptom Severity Score (SSS) and Quality of Life (HR-QoL) Subscales of the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) Questionnaire at 12 Months | Mean Change in HR-QoL at 12 Months | 43.7 points on a scale | Standard Deviation 24.25 |
Secondary
Change in Work Productivity and Activity Impairment Due to Uterine Fibroid Symptoms at 12 Months
The Work Productivity and Activity Impairment questionnaire for a specific health problem (WPAI:SHP) is a standardized instrument for making a quantitative assessment of work impairment and activity impairment attributable to a specific health problem (WPAI:SHP). The assessments are expressed in percentages. The endpoint assessed the difference in these percentages from baseline to 12 months.
Time frame: Baseline and 12 Months
Population: Subset of the Full Analysis Population who were employed and had paired responses at baseline and 12 months.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Subjects Treated With Sonata | Change in Work Productivity and Activity Impairment Due to Uterine Fibroid Symptoms at 12 Months | Change in mean Overall Work Impairment | -40.0 percentage change | Standard Deviation 34.22 |
| Subjects Treated With Sonata | Change in Work Productivity and Activity Impairment Due to Uterine Fibroid Symptoms at 12 Months | Change in mean Activity Impairment | -46.2 percentage change | Standard Deviation 31.21 |
Secondary
Mean Length of Stay
Length of stay (in hours) was assessed by recording the duration from the start of the procedure to discharge.
Time frame: Day 0 - Day of Treatment
Population: Safety Population - all treated subjects (147).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Subjects Treated With Sonata | Mean Length of Stay | 2.54 Hours | Standard Deviation 1.243 |
Secondary
Occurrence of Pregnancy
Subjects were asked about the possible occurrence of pregnancy.
Time frame: All Follow-up Visits through 24 Months
Population: Full Analysis Population (143 subjects).
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Subjects Treated With Sonata | Occurrence of Pregnancy | 1 Participants |
Secondary
Overall Treatment Effect (OTE) at 12 Months
The Overall Treatment Effect is a questionnaire for subjects to report their perceived treatment benefit at a given timepoint as either improved, no change, or worsened.
Time frame: 12 Months
Population: Full Analysis Population without imputation for this outcome measure.
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Subjects Treated With Sonata | Overall Treatment Effect (OTE) at 12 Months | Fibroid Symptoms Improved | 130 Participants |
| Subjects Treated With Sonata | Overall Treatment Effect (OTE) at 12 Months | Fibroid Symptoms Unchanged | 4 Participants |
| Subjects Treated With Sonata | Overall Treatment Effect (OTE) at 12 Months | Fibroid Symptoms Worsened | 1 Participants |
Secondary
Percentage Change in Total and Perfused Mean Maximal Fibroid Volumes at 12 Months
The percent change in total and perfused volume of dominant fibroid were determined by comparing contrast-enhanced MRI at baseline and at 12 months.
Time frame: Baseline and 12 Months
Population: Full Analysis Population without imputation for this outcome measure.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Subjects Treated With Sonata | Percentage Change in Total and Perfused Mean Maximal Fibroid Volumes at 12 Months | % Change in Total Mean Maximal Fibroid Volume | -62.4 percentage change | Standard Deviation 32.81 |
| Subjects Treated With Sonata | Percentage Change in Total and Perfused Mean Maximal Fibroid Volumes at 12 Months | % Change in Perfused Mean Maximal Fibroid Volume | -63.9 percentage change | Standard Deviation 31.44 |
Secondary
Pregnancy Outcome - Birth Weight
If pregnancy occurred during the study follow-up period, information regarding birth weight was collected.
Time frame: 24 Months
Population: 1 subject with pregnancy
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Subjects Treated With Sonata | Pregnancy Outcome - Birth Weight | 4005 grams |
Secondary
Pregnancy Outcome - Gestation Age
If pregnancy occurred during the study follow-up period, information regarding gestation age was collected.
Time frame: 24 Months
Population: 1 subject with pregnancy
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Subjects Treated With Sonata | Pregnancy Outcome - Gestation Age | 38.2 weeks |
Secondary
Procedure Tolerance
Prior to discharge, subjects were asked to rate their tolerance of the procedure. The possible responses were very tolerable, moderately tolerable, minimally tolerable, intolerable.
Time frame: Post-procedure (Day 0)
Population: Safety Population - all treated subjects (147).
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Subjects Treated With Sonata | Procedure Tolerance | Very Tolerable | 95 Participants |
| Subjects Treated With Sonata | Procedure Tolerance | Moderately Tolerable | 45 Participants |
| Subjects Treated With Sonata | Procedure Tolerance | Minimally Tolerable | 4 Participants |
| Subjects Treated With Sonata | Procedure Tolerance | Intolerable | 3 Participants |
Secondary
Safety - Percentage of Subjects With Adverse Device Effects (Serious or Non-serious)
Procedure safety was assessed by recording all adverse device effects that occured during or subsequent to treatment on the day of the procedure. Longer-term safety was assessed by recording any untoward medical occurrence since baseline at each follow-up visit.
Time frame: Each Follow-up Visit through 24 Months
Population: Safety population - all subjects who recieved the Sonata treatment.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Subjects Treated With Sonata | Safety - Percentage of Subjects With Adverse Device Effects (Serious or Non-serious) | 0 Participants |
Secondary
Subject Pain
Prior to discharge, subjects were asked to rate their experience of pain using a pain Visual Analog Scale (VAS). The VAS for pain is a measurement instrument by which subjects report the intensity of their pain with a quantitative value from 0 (no pain) to 10 (worst pain ever).
Time frame: Immediately Post-procedure as well as Pre-discharge (Day 0)
Population: Safety Population - all treated subjects (147).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Subjects Treated With Sonata | Subject Pain | Overall Pain During Procedure | 0.24 score on a scale from 0 to 10 | Standard Deviation 0.948 |
| Subjects Treated With Sonata | Subject Pain | Overall Pain During Recovery | 2.63 score on a scale from 0 to 10 | Standard Deviation 2.771 |
Secondary
Subject Satisfaction With Treatment at 12 Months
Subjects were asked to rate their level of satisfaction with the treatment. The possible ratings were as follows: very satisfied, moderately satisfied, somewhat satisfied, somewhat dissatisfied, moderately dissatisfied, and very dissatisfied.
Time frame: 12 Months
Population: Full Analysis Population without imputation for this outcome measure.
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Subjects Treated With Sonata | Subject Satisfaction With Treatment at 12 Months | Very Satisfied | 95 Participants |
| Subjects Treated With Sonata | Subject Satisfaction With Treatment at 12 Months | Modeately Satisfied | 24 Participants |
| Subjects Treated With Sonata | Subject Satisfaction With Treatment at 12 Months | Somewhat Satisfied | 12 Participants |
| Subjects Treated With Sonata | Subject Satisfaction With Treatment at 12 Months | Somewhat Dissatisfied | 3 Participants |
| Subjects Treated With Sonata | Subject Satisfaction With Treatment at 12 Months | Moderately Dissatisfied | 1 Participants |
| Subjects Treated With Sonata | Subject Satisfaction With Treatment at 12 Months | Very Dissatisfied | 0 Participants |
Secondary
Subject Willingness to Recommend Procedure at 12 Months
Subjects were asked whether they would recommend the procedure to a friend with the same health problems. The possible responses were: definitely yes, probably yes, probably no, and definitely no.
Time frame: 12 Months
Population: Full Analysis Population without imputation for this outcome measure.
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Subjects Treated With Sonata | Subject Willingness to Recommend Procedure at 12 Months | Definitely Yes | 110 Participants |
| Subjects Treated With Sonata | Subject Willingness to Recommend Procedure at 12 Months | Probably Yes | 21 Participants |
| Subjects Treated With Sonata | Subject Willingness to Recommend Procedure at 12 Months | Probably No | 4 Participants |
| Subjects Treated With Sonata | Subject Willingness to Recommend Procedure at 12 Months | Definitely No | 0 Participants |
Secondary
Time to Return to Normal Activity (RTNA) in Days
Subjects were given a questionnaire at discharge and asked to daily respond to the questionnaire on whether or not they returned to normal activities.
Time frame: 30 Day post-procedure
Population: Full Analysis Population without imputation for this outcome measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Subjects Treated With Sonata | Time to Return to Normal Activity (RTNA) in Days | 2.2 Days | Standard Deviation 2.23 |