I once worked for an Entity Framework SaaS company that was having horrific T-SQL performance issues. We put out a major release one weekend and spent the subsequent week buried in horrible performance hell. Because all T-SQL code was generated from Entity Framework (stored procedures were banned by a development exec prior to me joining the company), there were no easy fixes that could be implemented (and a Production release typically took 12 – 36 hours, I wish I was joking).
The manager of infrastructure had heard about SQL Server’s missing index recommendations:
Yep, it ends about as poorly as you’d expect.