Objective: To investigate the efficacy of splenectomy for refractory idiopathic thrombocytopenic purpura (ITP) and its affecting factors. Methods: The clinical data of 62 patients with refractory ITP undergoing splenectomy over 15 years were reviewed, and the relations of the efficacy of splenectomy with age, gender, preoperative bleeding, preoperative response to hormone treatment, spleen enlargement, and platelet peak were analyzed. Results: Of the 62 patients, 34 were very effective cases, 13 were favorably effective cases, 10 cases were improved, and 5 cases were completely ineffective. The efficacy rate ( very effective cases plus favorably effective cases) was 75.8%. The efficacy of splenectomy was unrelated to gender and whether the spleen was enlarged (both P<0.05). However, the differences between the groups classified according to whether the patients had bleeding symptoms, age, postoperative platelet peak and bone marrow megakaryocyte count had statistical significance. Multivariate analysis indicated that preoperative hormone response and preoperative platelet count were the main factors affecting the efficacy of splenectomy for refractory ITP (both P<0.05). Conclusion: Preoperative hormone response and preoperative platelet count can be used as the prediction indexes for the efficacy of splenectomy in patients with refractory ITP.