Background: Citation count is a common bibliometric tool used to determine the long-term impact and performance of journal articles. Many of the other potential factors associated with highly and lowly cited articles in the general surgery literature, however, remain unknown. The purpose of this study was to attempt to identify characteristics of articles that may predict or correlate with article citation counts and, consequently, article impact. Methods: We identified articles from Annals of Surgery, British Journal of Surgery, and Journal of the American College of Surgeons between 1998 and 2008 that had 0-5 total citations. We then matched these articles to an identical number of the highest cited articles from these same journals for comparison. Student's t-tests, Wilcoxon rank-sum tests, chi-squared tests, and Fisher's exact tests were used to determine the significance of difference between data sets at a predetermined level of significance set to P < 0.05. Results: Significant differences of article characteristics between the two cohorts included higher prevalence of clinical studies (P = 0.3919), multi-institutional (P = 0.0007) and multi-national (P = 0.0023) studies, surgical oncology (P < 0.0001) or hepatobiliary focus (P < 0.0001) and published in Annals of Surgery (P < 0.0001) for the highly cited cohort. Highly cited articles were also more likely to have larger sample sizes (P = 0.0009), more authors (P < 0.0001), presence of statistically significant results (P < 0.0001), more references (P < 0.0001), more tables (P < 0.0001), more figures (P = 0.0001), and higher word counts for manuscript (P < 0.0001), abstract (P < 0.0001), and title (P < 0.0001). Conclusions: There are a relatively small number of articles with 0-5 citations after 10 y for these major general surgery journals. This indicates that journals are consistently able to select articles that will be impactful in aiding future research. Certain factors, however, are associated with being highly cited as opposed to lowly cited, and an understanding of these factors can aid researchers and journals in designing and reporting future studies.