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When is cardiac surgery unneccesary?

Tenet Healthcare is innocent until proven guilty, but the multiplicity of investigations into whether they have performed unneccessary cardiac surgery makes me want to keep an eye on this story.

How could prosecutors prove that unneccessary surgeries were performed? How clear is the generally accepted medical standard for concluding that surgery is necessary in any particular case? We can imagine cases where it would be easy to tell; if anyone performed bypass surgery on me, for example, most docs would think that was unnecessary.

But what about the typical patient with some evidence of coronary atherosclerosis and some symptoms? It seems you could make an argument for or against surgery in most cases like this.

And what about the patient? Deciding whether surgery is necessary or not depends significantly on what the patient wants, right? How does the patient weigh the risks of surgery against the potential benefits? What about the risks of postponing surgery?

Can any of these calculations be determined by a chart review? Would prosecutors have to find the patients and interview them? Would they change their story now that surgery has been performed?

It seems to me that the prosecutors have an uphill battle here.