Bring a large pot of well-salted water to a boil. Add the orecchiette and cook until just under al dente — it will finish cooking in the skillet, so you want it to still have a bit of bite. Before draining, reserve ¼ cup of pasta water, then drain and set the pasta aside.
16 oz orecchiette
While the pasta cooks, heat a large skillet over medium-high heat. Add the sausage and let it sit undisturbed for 1-2 minutes to get some color on the first side. Then break it up into small pieces and continue cooking until no pink remains. Remove the sausage from the pan and set aside, leaving as much of the fat in the pan as you can.
1 lb hot Italian sausage
With the skillet still on medium-high heat, add a tablespoon of olive oil if the pan looks dry. Add the brussels sprouts and season with salt, pepper, garlic powder, and crushed red pepper. Cook, stirring occasionally, until the sprouts are cooked through and have picked up some color, about 4-5 minutes depending on their size.
12 oz brussels sprouts, 1 tablespoons olive oil, kosher salt, ¼ teaspoon black pepper, ½ teaspoon crushed red pepper, ½ teaspoon garlic powder
Add the sausage back to the pan along with the cooked pasta, pesto, parmesan, and reserved pasta water. Toss everything together until well combined. Taste and adjust seasoning. Serve topped with extra parmesan, freshly cracked black pepper, and a drizzle of olive oil.
½ basil pesto, ½ cup parmesan cheese