I used to use SQS but Postgres gives me everything I want. I can also do priority queueing and sorting.
I gave up on SQS when it couldn't be accessed from a VPC. AWS might have fixed that now.
All the other queueing mechanisms I investigated were dramatically more complex and heavyweight than Postgres SKIP LOCKED.
As for acking, I see two common methods: using an additional boolean column, something like is_processed. Consumers skip truthy ones. Or, after the work is done, simply delete the entry or move elsewhere (e.g. For archival / auditing).
Offcourse one could delay the commit until all processing is completed but then reasoning about the queue throughput becomes tricky.
The SKIP LOCKED bit means that once the queue item has been grabbed FOR UPDATE, it cannot then be grabbed FOR UPDATE by any other queries, so it has an exclusive lock on the worker queue item.
It's pretty robust and works fine for servicing multiple workers.